PROVENT SLEEP APNEA DEVICE,NASAL,STARTER KIT (23581)    VA PRODUCT (50.68)

Name Value
NAME PROVENT SLEEP APNEA DEVICE,NASAL,STARTER KIT
VA GENERIC NAME SLEEP APNEA
DOSAGE FORM DEVICE
FORMULARY DESIGNATOR PA-F
NATIONAL FORMULARY INDICATOR NO
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2021-09-15 00:00:00
NATIONAL FORMULARY NAME SLEEP APNEA DEVICE
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 PROVENT SLEEP APNEA NASAL STARTER KIT
VA PRODUCT IDENTIFIER XH167
TRANSMIT TO CMOP NO
VA DISPENSE UNIT KIT
MASTER ENTRY FOR VUID YES
VUID 4032054
EFFECTIVE DATE/TIME
  • 2013-02-19 00:00:00
    STATUS:   ACTIVE
  • 2021-09-15 00:00:00
    STATUS:   INACTIVE
  • 2021-09-15 00:00:00
    STATUS:   INACTIVE
  • 2021-09-15 00:00:00
    STATUS:   INACTIVE