CONTACT LENS PRESERVED SALINE SOLN (10091) VA PRODUCT (50.68)

Name	Value
NAME	CONTACT LENS PRESERVED SALINE SOLN
VA GENERIC NAME	CONTACT LENS SALINE,PRESERVED
DOSAGE FORM	SOLN,CONTACT LENS
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to veterans who receive their contact lens from the VA
ACTIVE INGREDIENTS	SODIUM METAPHOSPHATE SODIUM BORATE SODIUM CHLORIDE SODIUM HYDROXIDE EDTA STRENGTH: 0.01 UNITS: % THIMEROSAL STRENGTH: 0.001 UNITS: % BORIC ACID
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
DSS NUMBER	1
NATIONAL FORMULARY NAME	CONTACT LENS SALINE,PRESERVED SOLN,CONTACT LENS
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
VA PRINT NAME	CONTACT LENS PRESERVED SALINE SOLN
VA PRODUCT IDENTIFIER	C1976
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4010474
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE