SPONGE,DRAIN 4IN X 4IN 12-PLY DYNAREX #4612 (28758)    VA PRODUCT (50.68)

Name Value
NAME SPONGE,DRAIN 4IN X 4IN 12-PLY DYNAREX #4612
VA GENERIC NAME DRAIN
DOSAGE FORM SPONGE
NATIONAL FORMULARY NAME DRAIN SPONGE
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2018-09-13 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME SPONGE,DRAIN 4INX4IN 12-PLY DYNAREX#4612
VA PRODUCT IDENTIFIER XJ440
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4037818
EFFECTIVE DATE/TIME
  • 2018-09-13 00:00:00
    STATUS:   ACTIVE