POUCH,UROSTOMY ESTEEM SYNERGY C#4054-52 (25776)    VA PRODUCT (50.68)

Name Value
NAME POUCH,UROSTOMY ESTEEM SYNERGY C#4054-52
VA GENERIC NAME POUCH,UROSTOMY
DOSAGE FORM POUCH
NATIONAL FORMULARY NAME POUCH,UROSTOMY 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,UROSTOMY ESTEEM SYNERGY C#4054-52
VA PRODUCT IDENTIFIER XI070
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4034527
EFFECTIVE DATE/TIME
  • 2015-06-16 00:00:00
    STATUS:   ACTIVE