| NAME |
KERLIX AMD SUPER SPONGE MEDIUM 6IN X 6.75IN |
| VA GENERIC NAME |
SUPPLY |
| DOSAGE FORM |
SPONGE |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
SUPPLY 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 |
KERLIX AMD SUPER SPONGE MEDIUM 6X6.75IN |
| VA PRODUCT IDENTIFIER |
XH576 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033233 |
| EFFECTIVE DATE/TIME |
-
- 2014-04-17 00:00:00
- STATUS: ACTIVE
|
