TRACER BG (TRACER II) TEST STRIP (8016)    VA PRODUCT (50.68)

Name Value
NAME TRACER BG (TRACER II) 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 14
NATIONAL FORMULARY NAME GLUCOSE TEST TEST STRIP
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 4008492
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-27 00:00:00
    STATUS:   INACTIVE