| NAME |
DEXTROSE 25GM/60GM SQUEEZE TUBE |
| VA GENERIC NAME |
DEXTROSE |
| DOSAGE FORM |
LIQUID |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
25 |
| UNITS |
GM |
| DSS NUMBER |
19 |
| NATIONAL FORMULARY NAME |
DEXTROSE LIQUID |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DEXTROSE 25GM/60GM SQUEEZE TUBE |
| VA PRODUCT IDENTIFIER |
D0190 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4004218 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
