| NAME |
CLEANSER,SKINTEGRITY SPRAY,TOP |
| VA GENERIC NAME |
SKINTEGRITY |
| DOSAGE FORM |
SPRAY,TOP |
| FORMULARY DESIGNATOR TEXT |
Not supplied by pharmacy for inpatient use.
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
SKINTEGRITY SPRAY,TOP |
| 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: 2017-05-31 00:00:00
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-06-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
CLEANSER,WOUND SKINTEGRITY TOP SPRAY |
| VA PRODUCT IDENTIFIER |
C1485 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4026134 |
| EFFECTIVE DATE/TIME |
-
- 2007-06-19 00:00:00
- STATUS: ACTIVE
|
