POUCH,DRAINABLE,ESTEEM C#4135-16 (27033)    VA PRODUCT (50.68)

Name Value
NAME POUCH,DRAINABLE,ESTEEM C#4135-16
VA GENERIC NAME POUCH,OSTOMY
DOSAGE FORM POUCH
NATIONAL FORMULARY NAME POUCH,OSTOMY 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,DRAINABLE,ESTEEM C#4135-16
VA PRODUCT IDENTIFIER XI612
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4035904
EFFECTIVE DATE/TIME
  • 2016-07-20 00:00:00
    STATUS:   ACTIVE