| NAME |
DRESSING,ALLEVYN LIFE FOAM 4IN X 4IN U#66021067 |
| VA GENERIC NAME |
DRESSING |
| DOSAGE FORM |
DRESSING,TOP |
| NATIONAL FORMULARY NAME |
DRESSING DRESSING,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 4X4IN U#66021067 |
| VA PRODUCT IDENTIFIER |
XI765 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036239 |
| EFFECTIVE DATE/TIME |
-
- 2016-12-13 00:00:00
- STATUS: ACTIVE
|
