SPONGE,DRAIN 2IN X 2IN EXCILON AMD KEN#7089 (21275)    VA PRODUCT (50.68)

Name Value
NAME SPONGE,DRAIN 2IN X 2IN EXCILON AMD KEN#7089
VA GENERIC NAME DRAIN
DOSAGE FORM SPONGE
ACTIVE INGREDIENTS
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 2X2IN EXCILON AMD KEN#7089
VA PRODUCT IDENTIFIER XT272
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4029408
EFFECTIVE DATE/TIME
  • 2009-12-04 00:00:00
    STATUS:   ACTIVE