PROGAINE NORMAL TO DRY SHAMPOO (9969) VA PRODUCT (50.68)

Name	Value
NAME	PROGAINE NORMAL TO DRY SHAMPOO
VA GENERIC NAME	PROGAINE
DOSAGE FORM	SHAMPOO
ACTIVE INGREDIENTS	PROPYLENE GLYCOL COCAMIDE DEA SODIUM LAURETH SULFATE TEA-LAURYL SULFATE COCAMIDOPROPYL BETAINE SODIUM CHLORIDE CITRIC ACID EDETATE DISODIUM
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-10-01 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	PROGAINE SHAMPOO
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4010359
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-10-01 00:00:00 STATUS: INACTIVE