DEXTRANOMER 50MG/HYALURONATE 15MG/ML INJ,SYR,1ML (25950)    VA PRODUCT (50.68)

Name Value
NAME DEXTRANOMER 50MG/HYALURONATE 15MG/ML INJ,SYR,1ML
VA GENERIC NAME DEXTRANOMER/HYALURONATE
DOSAGE FORM INJ
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2020-12-15 00:00:00
NATIONAL FORMULARY NAME DEXTRANOMER/HYALURONATE INJ
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME DEXTRANOMER 50MG/HYALURONATE 15MG/ML 1ML
VA PRODUCT IDENTIFIER D1110
TRANSMIT TO CMOP NO
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4034724
EFFECTIVE DATE/TIME
  • 2015-08-14 00:00:00
    STATUS:   ACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE