CONTACT LENS SOLN (PURILENS PLUS) (31172)    VA PRODUCT (50.68)

Name Value
NAME CONTACT LENS SOLN (PURILENS PLUS)
VA GENERIC NAME BORIC ACID/SODIUM BORATE/SODIUM CHLORIDE
DOSAGE FORM SOLN,CONTACT LENS
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to veterans who receive their contact lens from the VA
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
NATIONAL FORMULARY NAME BORIC ACID/SODIUM BORATE/SODIUM CHLORIDE SOLN,CONTACT LENS
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-06-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME CONTACT LENS SOLN (PURILENS PLUS)
VA PRODUCT IDENTIFIER C1996
TRANSMIT TO CMOP NO
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4040529
EFFECTIVE DATE/TIME
  • 2021-06-01 00:00:00
    STATUS:   ACTIVE
  • 2021-06-01 00:00:00
    STATUS:   ACTIVE
  • 2021-06-01 00:00:00
    STATUS:   ACTIVE