CHONDROITIN NA 40MG/HYALURONATE NA 30MG/ML INJ,OPH,SYRINGE,0.5ML (12574) VA PRODUCT (50.68)

Name	Value
NAME	CHONDROITIN NA 40MG/HYALURONATE NA 30MG/ML INJ,OPH,SYRINGE,0.5ML
VA GENERIC NAME	CHONDROITIN/HYALURONATE
DOSAGE FORM	INJ
ACTIVE INGREDIENTS	HYALURONATE SODIUM STRENGTH: 30 UNITS: MG/ML CHONDROITIN SODIUM STRENGTH: 40 UNITS: MG/ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	1
NATIONAL FORMULARY NAME	CHONDROITIN/HYALURONATE INJ
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	VISCOAT OPH INJ SYRINGE 0.5ML
VA PRODUCT IDENTIFIER	V0063
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	SYRINGE
MASTER ENTRY FOR VUID	YES
VUID	4012939
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE