| NAME |
DEXTROSE 15GM/32ML GEL,ORAL,PKT |
| VA GENERIC NAME |
DEXTROSE |
| DOSAGE FORM |
GEL,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
DEXTROSE GEL,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-01-26 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DEXTROSE 15GM/32ML ORAL GEL PKT |
| VA PRODUCT IDENTIFIER |
D1277 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041115 |
| EFFECTIVE DATE/TIME |
-
- 2022-01-26 00:00:00
- STATUS: ACTIVE
|
