| NAME |
DRESSING,PROMOGRAN PRISMA MATRIX 19.1SQ IN JJ#MA123 |
| VA GENERIC NAME |
PROMOGRAN PRISMA MATRIX |
| DOSAGE FORM |
DRESSING,TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2014-02-19 00:00:00 |
| NATIONAL FORMULARY NAME |
PROMOGRAN PRISMA MATRIX DRESSING,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
PROMOGRAN PRISMA 19.1SQ IN JJ#MA123 |
| VA PRODUCT IDENTIFIER |
XT105 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4029144 |
| EFFECTIVE DATE/TIME |
-
- 2009-10-01 00:00:00
- STATUS: ACTIVE
|
