| NAME |
HYALURONATE SODIUM 0.3%/UREA 40% EMULSION,TOP |
| VA GENERIC NAME |
HYALURONATE/UREA |
| DOSAGE FORM |
EMULSION,TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2017-07-17 00:00:00 |
| NATIONAL FORMULARY NAME |
HYALURONATE/UREA EMULSION,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
HYALURONATE NA 0.3/UREA 40% TOP EMULSION |
| VA PRODUCT IDENTIFIER |
H0679 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034013 |
| EFFECTIVE DATE/TIME |
-
- 2014-12-30 00:00:00
- STATUS: ACTIVE
|
