| NAME |
DEXTRANOMER PASTE,TOP,10GM,STERILE |
| VA GENERIC NAME |
DEXTRANOMER |
| DOSAGE FORM |
PASTE |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2011-04-07 00:00:00 |
| DSS NUMBER |
3 |
| NATIONAL FORMULARY NAME |
DEXTRANOMER PASTE |
| 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 |
DEXTRANOMER PASTE TOP 10GM STERILE |
| VA PRODUCT IDENTIFIER |
D0350 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008475 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2011-04-07 00:00:00
- STATUS: INACTIVE
|
