POUCH,UROSTOMY,PREMIER H#84798 (28254)    VA PRODUCT (50.68)

Name Value
NAME POUCH,UROSTOMY,PREMIER H#84798
VA GENERIC NAME POUCH,UROSTOMY
DOSAGE FORM POUCH
NATIONAL FORMULARY NAME POUCH,UROSTOMY POUCH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2018-03-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POUCH,UROSTOMY,PREMIER H#84798
VA PRODUCT IDENTIFIER XJ187
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037241
EFFECTIVE DATE/TIME
  • 2018-01-25 00:00:00
    STATUS:   ACTIVE