SPONGE,DRAIN 4IN X 4IN EXCILON AMD KEN#7088 (20835)    VA PRODUCT (50.68)

Name Value
NAME SPONGE,DRAIN 4IN X 4IN EXCILON AMD KEN#7088
VA GENERIC NAME DRAIN
DOSAGE FORM SPONGE
NATIONAL FORMULARY NAME DRAIN SPONGE
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 SPONGE,DRAIN 4X4IN EXCILON AMD KEN#7088
VA PRODUCT IDENTIFIER S0630
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4028901
EFFECTIVE DATE/TIME
  • 2009-08-11 00:00:00
    STATUS:   ACTIVE