HYALURONATE NA 2.5% GEL,TOP (28777)    VA PRODUCT (50.68)

Name Value
NAME HYALURONATE NA 2.5% GEL,TOP
VA GENERIC NAME HYALURONATE SODIUM
DOSAGE FORM GEL,TOP
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 2.5
SINGLE/MULTI SOURCE PRODUCT Multisource
UNITS %
NATIONAL FORMULARY NAME HYALURONATE SODIUM GEL,TOP
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2018-09-24 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME HYALURONATE NA 2.5% TOP GEL
VA PRODUCT IDENTIFIER H0738
TRANSMIT TO CMOP YES
VA DISPENSE UNIT GM
MASTER ENTRY FOR VUID YES
VUID 4037838
EFFECTIVE DATE/TIME
  • 2018-09-24 00:00:00
    STATUS:   ACTIVE
  • 2020-01-15 00:00:00
    STATUS:   INACTIVE
  • 2021-05-17 00:00:00
    STATUS:   ACTIVE
  • 2021-07-14 00:00:00
    STATUS:   ACTIVE
  • 2021-11-04 00:00:00
    STATUS:   ACTIVE