POUCH,DRAINABLE,NEW IMAGE KIT H#19052 (20903)    VA PRODUCT (50.68)

Name Value
NAME POUCH,DRAINABLE,NEW IMAGE KIT H#19052
VA GENERIC NAME POUCH,OSTOMY
DOSAGE FORM KIT
NATIONAL FORMULARY NAME POUCH,OSTOMY KIT
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,NEW IMAGE KIT H#19052
VA PRODUCT IDENTIFIER XU980
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4028983
EFFECTIVE DATE/TIME
  • 2009-09-09 00:00:00
    STATUS:   ACTIVE