SPONGE,DRAIN 4IN X 4IN SORB-IT KEN#6242P (14439)    VA PRODUCT (50.68)

Name Value
NAME SPONGE,DRAIN 4IN X 4IN SORB-IT KEN#6242P
VA GENERIC NAME DRAIN
DOSAGE FORM SPONGE
NATIONAL FORMULARY NAME DRAIN SPONGE
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 SPONGE,DRAIN 4IN X 4IN SORB-IT KEN#6242P
VA PRODUCT IDENTIFIER XY255
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4014803
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE