POUCH,DRAINABLE,GUARDIAN H#4612 (10655)    VA PRODUCT (50.68)

Name Value
NAME POUCH,DRAINABLE,GUARDIAN H#4612
VA GENERIC NAME POUCH,OSTOMY
DOSAGE FORM POUCH
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2003-03-17 00:00:00
DSS NUMBER 331
NATIONAL FORMULARY NAME POUCH,OSTOMY POUCH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POUCH,DRAINABLE,GUARDIAN H#4612
VA PRODUCT IDENTIFIER XS285
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4011028
EFFECTIVE DATE/TIME
  • 2003-03-17 00:00:00
    STATUS:   INACTIVE
  • 2005-12-08 00:00:00
    STATUS:   INACTIVE