ADHESIVE REMOVER WIPE PROVOX #8012 (28430)    VA PRODUCT (50.68)

Name Value
NAME ADHESIVE REMOVER WIPE PROVOX #8012
VA GENERIC NAME ADHESIVE REMOVER
DOSAGE FORM PAD
NATIONAL FORMULARY NAME ADHESIVE REMOVER PAD
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2018-05-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME ADHESIVE REMOVER WIPE PROVOX #8012
VA PRODUCT IDENTIFIER XJ276
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037439
EFFECTIVE DATE/TIME
  • 2018-04-04 00:00:00
    STATUS:   ACTIVE