GLUCOSE SENSOR FREESTYLE LIBRE (28047)    VA PRODUCT (50.68)

Name Value
NAME GLUCOSE SENSOR FREESTYLE LIBRE
VA GENERIC NAME GLUCOSE SENSOR
DOSAGE FORM MISCELLANEOUS
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2020-09-15 00:00:00
NATIONAL FORMULARY NAME GLUCOSE SENSOR MISCELLANEOUS
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2017-12-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME GLUCOSE SENSOR FREESTYLE LIBRE
VA PRODUCT IDENTIFIER XJ100
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037033
EFFECTIVE DATE/TIME
  • 2017-11-02 00:00:00
    STATUS:   ACTIVE
  • 2020-09-15 00:00:00
    STATUS:   INACTIVE
  • 2020-09-15 00:00:00
    STATUS:   INACTIVE
  • 2020-09-15 00:00:00
    STATUS:   INACTIVE