POUCH,DRAINABLE,SUR-FIT C#4206-97 (28563)    VA PRODUCT (50.68)

Name Value
NAME POUCH,DRAINABLE,SUR-FIT C#4206-97
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:   2018-06-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POUCH,DRAINABLE,SUR-FIT C#4206-97
VA PRODUCT IDENTIFIER XJ345
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037587
EFFECTIVE DATE/TIME
  • 2018-06-04 00:00:00
    STATUS:   ACTIVE
  • 2018-06-04 00:00:00
    STATUS:   ACTIVE