
| Name | Value |
|---|---|
| NAME | ELECTRODE GEL,LASER TOUCH ONE |
| VA GENERIC NAME | SUPPLY |
| DOSAGE FORM | GEL |
| HAZARDOUS TO DISPOSE | NO |
| NATIONAL FORMULARY NAME | SUPPLY GEL |
| CREATE DEFAULT POSSIBLE DOSAGE | YES |
| CODING SYSTEM |
|
| COPAY TIER |
|
| PGX ELIGIBLE | NO |
| PGX SUPPRESSED | NO |
| VA PRINT NAME | ELECTRODE GEL,LASER TOUCH ONE |
| VA PRODUCT IDENTIFIER | XL266 |
| TRANSMIT TO CMOP | NO |
| VA DISPENSE UNIT | GM |
| MASTER ENTRY FOR VUID | YES |
| VUID | 4041568 |
| EFFECTIVE DATE/TIME |
|