DIAPHRAGM KIT OMNIFLEX 75MM (25234)    VA PRODUCT (50.68)

Name Value
NAME DIAPHRAGM KIT OMNIFLEX 75MM
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 75MM
VA PRODUCT IDENTIFIER XH816
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4033924
EFFECTIVE DATE/TIME
  • 2014-12-12 00:00:00
    STATUS:   ACTIVE