PEG-400 0.25% GEL,OPH (31508)    VA PRODUCT (50.68)

Name Value
NAME PEG-400 0.25% GEL,OPH
VA GENERIC NAME POLYETHYLENE GLYCOL 400
DOSAGE FORM GEL,OPH
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
  • PEG-400
    STRENGTH:   0.25
    UNITS:   %
STRENGTH 0.25
UNITS %
NATIONAL FORMULARY NAME POLYETHYLENE GLYCOL 400 GEL,OPH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-10-29 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POLYETHYLENE GLYCOL 400 0.25% OPH GEL
VA PRODUCT IDENTIFIER P1300
TRANSMIT TO CMOP NO
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4040905
EFFECTIVE DATE/TIME
  • 2021-10-29 00:00:00
    STATUS:   ACTIVE