| NAME |
ICODEXTRIN 7.5% SOLN |
| VA GENERIC NAME |
ICODEXTRIN |
| DOSAGE FORM |
SOLN,DIALYSIS |
| FDA MED GUIDE |
Icodextrin_(Extraneal)_(2010).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
7.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
ICODEXTRIN SOLN,DIALYSIS |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ICODEXTRIN 7.5% SOLN |
| VA PRODUCT IDENTIFIER |
I0353 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4016419 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2009-05-26 00:00:00
- STATUS: INACTIVE
-
- 2009-11-09 00:00:00
- STATUS: ACTIVE
|
