| NAME |
DEXTROSE 24GM/31GM SQUEEZE TUBE |
| VA GENERIC NAME |
DEXTROSE |
| DOSAGE FORM |
GEL,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
24 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
GM/31GM |
| NATIONAL FORMULARY NAME |
DEXTROSE GEL,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
DEXTROSE 24GM/31GM SQUEEZE TUBE |
| VA PRODUCT IDENTIFIER |
D1094 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033899 |
| EFFECTIVE DATE/TIME |
-
- 2014-12-03 00:00:00
- STATUS: ACTIVE
|
