PAD,SLEEVE,PEDIFOAM MEDIUM (17018)    VA PRODUCT (50.68)

Name Value
NAME PAD,SLEEVE,PEDIFOAM MEDIUM
VA GENERIC NAME PEDIFOAM
DOSAGE FORM PAD
NATIONAL FORMULARY NAME PEDIFOAM PAD
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 PAD,SLEEVE,PEDIFOAM MEDIUM
VA PRODUCT IDENTIFIER XZ923
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4017381
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE