| NAME |
TRACER BG (GLUCOSE) TEST STRIP |
| VA GENERIC NAME |
GLUCOSE TEST |
| DOSAGE FORM |
TEST STRIP |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY RESTRICTION |
Refer to PBM/MAP and PBM/TAG Diabetes treatment guidelines
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2007-09-27 00:00:00 |
| DSS NUMBER |
11 |
| NATIONAL FORMULARY NAME |
GLUCOSE TEST TEST STRIP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TRACER BG GLUCOSE TEST STRIP |
| VA PRODUCT IDENTIFIER |
T0194 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
STRIP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008489 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2007-09-27 00:00:00
- STATUS: INACTIVE
|
