DRESSING,AQUACEL AG FOAM ADHESIVE 3.25IN X 3.25IN #420805 (28571)    VA PRODUCT (50.68)

Name Value
NAME DRESSING,AQUACEL AG FOAM ADHESIVE 3.25IN X 3.25IN #420805
VA GENERIC NAME DRESSING,AQUACEL FOAM
DOSAGE FORM DRESSING,TOP
ACTIVE INGREDIENTS
NATIONAL FORMULARY NAME DRESSING,AQUACEL FOAM DRESSING,TOP
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2018-06-07 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME DRESS,AQUACEL AG FOAM 3.25X3.25IN#420805
VA PRODUCT IDENTIFIER XJ346
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037596
EFFECTIVE DATE/TIME
  • 2018-06-07 00:00:00
    STATUS:   ACTIVE
  • 2018-06-07 00:00:00
    STATUS:   ACTIVE