| NAME |
AMERIGEL SALINE WOUND WASH |
| VA GENERIC NAME |
AMERIGEL |
| DOSAGE FORM |
LIQUID,TOP |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
AMERIGEL LIQUID,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: 2017-06-30 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 |
AMERIGEL SALINE WOUND WASH |
| VA PRODUCT IDENTIFIER |
A1371 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4026210 |
| EFFECTIVE DATE/TIME |
-
- 2007-07-24 00:00:00
- STATUS: ACTIVE
|
