POUCH,DRAINABLE,SUR-FIT C#4114-91 (18050)    VA PRODUCT (50.68)

Name Value
NAME POUCH,DRAINABLE,SUR-FIT C#4114-91
VA GENERIC NAME POUCH,OSTOMY
DOSAGE FORM POUCH
NATIONAL FORMULARY NAME POUCH,OSTOMY POUCH
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 POUCH,DRAINABLE,SUR-FIT C#4114-91
VA PRODUCT IDENTIFIER XV188
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4025767
EFFECTIVE DATE/TIME
  • 2006-11-29 00:00:00
    STATUS:   ACTIVE