| NAME |
POLIDOCANOL 10MG/ML INJ,FOAM KIT,18ML |
| VA GENERIC NAME |
POLIDOCANOL |
| DOSAGE FORM |
INJ |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
10 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
POLIDOCANOL INJ |
| 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 |
POLIDOCANOL 10MG/ML INJ,FOAM KIT,18ML |
| VA PRODUCT IDENTIFIER |
P1135 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034367 |
| EFFECTIVE DATE/TIME |
-
- 2015-04-16 00:00:00
- STATUS: ACTIVE
|
