POUCH,CLOSED,ESTEEM C#4167-01 (25323)    VA PRODUCT (50.68)

Name Value
NAME POUCH,CLOSED,ESTEEM C#4167-01
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#4167-01
VA PRODUCT IDENTIFIER XH853
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4034023
EFFECTIVE DATE/TIME
  • 2014-12-31 00:00:00
    STATUS:   ACTIVE