DIAPHRAGM KIT MILEX ARCING 75MM (26192)    VA PRODUCT (50.68)

Name Value
NAME DIAPHRAGM KIT MILEX ARCING 75MM
VA GENERIC NAME DIAPHRAGM
DOSAGE FORM DIAPHRAGM
NATIONAL FORMULARY NAME DIAPHRAGM DIAPHRAGM
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 DIAPHRAGM KIT MILEX ARCING 75MM
VA PRODUCT IDENTIFIER XI268
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4034984
EFFECTIVE DATE/TIME
  • 2015-10-28 00:00:00
    STATUS:   ACTIVE