DIAPHRAGM KIT OMNIFLEX 65MM (25232)    VA PRODUCT (50.68)

Name Value
NAME DIAPHRAGM KIT OMNIFLEX 65MM
VA GENERIC NAME DIAPHRAGM
DOSAGE FORM DIAPHRAGM
NATIONAL FORMULARY NAME DIAPHRAGM DIAPHRAGM
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 DIAPHRAGM KIT OMNIFLEX 65MM
VA PRODUCT IDENTIFIER XH814
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4033922
EFFECTIVE DATE/TIME
  • 2014-12-12 00:00:00
    STATUS:   ACTIVE