FAST-PAK ANGIOGRAPHY KIT WITH MD 76 (3411) VA PRODUCT (50.68)

Name	Value
NAME	FAST-PAK ANGIOGRAPHY KIT WITH MD 76
VA GENERIC NAME	DIATRIZOATE/LIDOCAINE
DOSAGE FORM	KIT
ACTIVE INGREDIENTS	DIATRIZOATE MEGLUMINE STRENGTH: 660 UNITS: MG DIATRIZOATE SODIUM STRENGTH: 100 UNITS: MG LIDOCAINE HYDROCHLORIDE STRENGTH: 1 UNITS: % POVIDONE-IODINE
CS FEDERAL SCHEDULE	Unscheduled
DSS NUMBER	1
NATIONAL FORMULARY NAME	DIATRIZOATE/LIDOCAINE KIT
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4003978
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE