| NAME |
DRESSING,HYDROGEL GEL,TOP |
| VA GENERIC NAME |
HYDROGEL |
| DOSAGE FORM |
GEL,TOP |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
HYDROGEL GEL,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DRESSING,HYDROGEL TOP GEL |
| VA PRODUCT IDENTIFIER |
XT481 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4029730 |
| EFFECTIVE DATE/TIME |
-
- 2010-04-12 00:00:00
- STATUS: ACTIVE
|
