| NAME |
LUBRICANT,PROSTHETIC OSL-XHEAVY B-304 LIQUID,OPH |
| VA GENERIC NAME |
SILICONE |
| DOSAGE FORM |
LIQUID,OPH |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY NAME |
SILICONE LIQUID,OPH |
| 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 |
LUBRICANT,PROSTHETI OSL-XHEAVY B-304 LIQ |
| VA PRODUCT IDENTIFIER |
L0583 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032403 |
| EFFECTIVE DATE/TIME |
-
- 2013-05-23 00:00:00
- STATUS: ACTIVE
|
