DRESSING,ALLEVYN LIFE FOAM 5 1/16IN X 5 1/16IN U#66801068 (25779)    VA PRODUCT (50.68)

Name Value
NAME DRESSING,ALLEVYN LIFE FOAM 5 1/16IN X 5 1/16IN U#66801068
VA GENERIC NAME DRESSING
DOSAGE FORM DRESSING,TOP
NATIONAL FORMULARY NAME DRESSING DRESSING,TOP
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 DRESSING,ALLEVYN LIFE 5 1/16 X 5 1/16IN
VA PRODUCT IDENTIFIER XI073
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4034530
EFFECTIVE DATE/TIME
  • 2015-06-17 00:00:00
    STATUS:   ACTIVE