POUCH,UROSTOMY ESTEEM PLUS C#4216-25 (30707)    VA PRODUCT (50.68)

Name Value
NAME POUCH,UROSTOMY ESTEEM PLUS C#4216-25
VA GENERIC NAME POUCH,UROSTOMY
DOSAGE FORM POUCH
HAZARDOUS TO DISPOSE NO
NATIONAL FORMULARY NAME POUCH,UROSTOMY POUCH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2021-02-08 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POUCH,UROSTOMY ESTEEM PLUS C#4216-25
VA PRODUCT IDENTIFIER XK377
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4040033
EFFECTIVE DATE/TIME
  • 2021-02-09 00:00:00
    STATUS:   ACTIVE
  • 2021-02-09 00:00:00
    STATUS:   ACTIVE
  • 2021-02-09 00:00:00
    STATUS:   ACTIVE