PEG-400 0.4%/PROPYLENE GLYCOL 0.3% SOLN,OPH (16886)    VA PRODUCT (50.68)

Name Value
NAME PEG-400 0.4%/PROPYLENE GLYCOL 0.3% SOLN,OPH
VA GENERIC NAME POLYETHYLENE GLYCOL 400/PROPYLENE GLYCOL
DOSAGE FORM SOLN,OPH
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME POLYETHYLENE GLYCOL 400/PROPYLENE GLYCOL SOLN,OPH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2019-12-31 00:00:00
  • COPAY TIER LEVEL:   1
    COPAY EFFECTIVE DATE:   2020-01-01 00:00:00
    COPAY END DATE:   2021-12-31 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2022-01-01 00:00:00
    COPAY END DATE:   2022-12-31 00:00:00
  • COPAY TIER LEVEL:   1
    COPAY EFFECTIVE DATE:   2023-01-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME PEG 400 0.4%/PROP GLYCOL 0.3% OPH SOLN
VA PRODUCT IDENTIFIER P0705
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4017249
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE