POUCH,CLOSED,ESTEEM C#4167-02 (24860)    VA PRODUCT (50.68)

Name Value
NAME POUCH,CLOSED,ESTEEM C#4167-02
VA GENERIC NAME POUCH,OSTOMY
DOSAGE FORM POUCH
NATIONAL FORMULARY NAME POUCH,OSTOMY POUCH
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 POUCH,CLOSED,ESTEEM C#4167-02
VA PRODUCT IDENTIFIER XH674
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4033496
EFFECTIVE DATE/TIME
  • 2014-07-11 00:00:00
    STATUS:   ACTIVE