| NAME |
SPONGE,DRAIN 4IN X 4IN 16-PLY MEDLINE #NON255000Z |
| VA GENERIC NAME |
DRAIN |
| DOSAGE FORM |
SPONGE |
| NATIONAL FORMULARY NAME |
DRAIN SPONGE |
| 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 |
SPONGE,DRAIN 4INX4IN 16-PLY M#NON255000Z |
| VA PRODUCT IDENTIFIER |
XH142 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031963 |
| EFFECTIVE DATE/TIME |
-
- 2013-01-15 00:00:00
- STATUS: ACTIVE
|
