MEDICATED DISPOSABLE DOUCHE (7688)    VA PRODUCT (50.68)

Name Value
NAME MEDICATED DISPOSABLE DOUCHE
VA GENERIC NAME POVIDONE IODINE
DOSAGE FORM DOUCHE
FORMULARY DESIGNATOR TEXT 
Not supplied by pharmacy for inpatient use.
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2008-09-30 00:00:00
DSS NUMBER 19
NATIONAL FORMULARY NAME POVIDONE IODINE DOUCHE
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    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 4008183
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2008-09-30 00:00:00
    STATUS:   INACTIVE