| NAME |
LUBRICANT,PROSTHETIC OCU-SIL LIQUID,OPH |
| VA GENERIC NAME |
SILICONE |
| DOSAGE FORM |
LIQUID,OPH |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY NAME |
SILICONE LIQUID,OPH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2018-09-12 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LUBE,PROSTHETIC OCU-SIL OPH LIQUID |
| VA PRODUCT IDENTIFIER |
L0765 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037812 |
| EFFECTIVE DATE/TIME |
-
- 2018-09-12 00:00:00
- STATUS: ACTIVE
|
