INCONT LINER TRANQUILITY BOOSTER #3096 (31287)    VA PRODUCT (50.68)

Name Value
NAME INCONT LINER TRANQUILITY BOOSTER #3096
VA GENERIC NAME PAD
DOSAGE FORM PAD
HAZARDOUS TO DISPOSE NO
NATIONAL FORMULARY NAME PAD PAD
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2021-07-13 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME INCONT LINER TRANQUILITY BOOSTER #3096
VA PRODUCT IDENTIFIER XK779
TRANSMIT TO CMOP NO
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4040653
EFFECTIVE DATE/TIME
  • 2021-07-13 00:00:00
    STATUS:   ACTIVE
  • 2021-07-13 00:00:00
    STATUS:   ACTIVE
  • 2021-07-13 00:00:00
    STATUS:   ACTIVE