| NAME |
SPONGE,OPTIPORE,STERILE |
| VA GENERIC NAME |
OPTIPORE |
| DOSAGE FORM |
SPONGE |
| NATIONAL FORMULARY NAME |
OPTIPORE SPONGE |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2017-06-30 00:00:00
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-07-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SPONGE,OPTIPORE,STERILE |
| VA PRODUCT IDENTIFIER |
S0429 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4017369 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
