HYALURONIC ACID/LIDOCAINE 0.3% (RESTYLANE-L) SYR (22595)    VA PRODUCT (50.68)

Name Value
NAME HYALURONIC ACID/LIDOCAINE 0.3% (RESTYLANE-L) SYR
VA GENERIC NAME HYALURONIC ACID/LIDOCAINE
DOSAGE FORM INJ
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2022-09-15 00:00:00
NATIONAL FORMULARY NAME HYALURONIC ACID/LIDOCAINE INJ
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME HYALURONIC ACID/LIDO (RESTYLANE-L) SYR
VA PRODUCT IDENTIFIER H0597
TRANSMIT TO CMOP NO
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4030902
EFFECTIVE DATE/TIME
  • 2011-08-08 00:00:00
    STATUS:   ACTIVE
  • 2022-09-15 00:00:00
    STATUS:   INACTIVE