MICRO-KLENZ,ANTIMICROBIAL WOUND CLEANSER (9984) VA PRODUCT (50.68)

Name	Value
NAME	MICRO-KLENZ,ANTIMICROBIAL WOUND CLEANSER
VA GENERIC NAME	MICRO-KLENZ
DOSAGE FORM	LIQUID,TOP
FORMULARY DESIGNATOR TEXT	Not supplied by pharmacy for inpatient use.
ACTIVE INGREDIENTS	POTASSIUM SORBATE SODIUM LAURYL SULFATE IMIDAZOLIDINYL UREA QUATERNIUM 15 ALOE VERA GEL METHYLPARABEN SODIUM METABISULFITE
CS FEDERAL SCHEDULE	Unscheduled
DSS NUMBER	1
NATIONAL FORMULARY NAME	MICRO-KLENZ LIQUID,TOP
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2017-05-31 00:00:00 COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2017-06-01 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	MICRO-KLENZ,ANTIMICROBIAL WOUND CLEANSER
VA PRODUCT IDENTIFIER	M0502
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4010374
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE