CONTACT LENS (FOR HARD LENS) SOLN (10105)    VA PRODUCT (50.68)

Name Value
NAME CONTACT LENS (FOR HARD LENS) SOLN
VA GENERIC NAME BENZALKONIUM CHLORIDE/EDTA
DOSAGE FORM SOLN,CONTACT LENS
FORMULARY DESIGNATOR TEXT 
Restricted to veterans who receive their contact lens from the VA
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2004-11-18 00:00:00
DSS NUMBER 1
NATIONAL FORMULARY NAME BENZALKONIUM CHLORIDE/EDTA SOLN
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 NO
VUID 4010488
EFFECTIVE DATE/TIME
  • 2004-11-18 00:00:00
    STATUS:   INACTIVE
  • 2005-12-08 00:00:00
    STATUS:   INACTIVE
  • 2005-12-08 00:00:00
    STATUS:   INACTIVE
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-19 00:00:00
    STATUS:   INACTIVE