| NAME |
CONTACT LENS WETTING SOLN |
| VA GENERIC NAME |
BENZALKONIUM CHLORIDE/HYDROXYPROPYL METHYLCELLULOSE/POLYVINYL AL |
| 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 |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
BENZALKONIUM CHLORIDE/HYDROXYPROPYL METHYLCELLULOSE/POLYVINYL AL SOLN,CONTACT LENS |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 WETTING SOLN |
| VA PRODUCT IDENTIFIER |
C1770 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4010484 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
