| NAME |
POLYVINYL ALCOHOL 1.4%/POVIDONE (PF) SOLN,OPH |
| VA GENERIC NAME |
POLYVINYL ALCOHOL/POVIDONE/SODIUM CHLORIDE |
| DOSAGE FORM |
SOLN,OPH |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
POLYVINYL ALCOHOL/POVIDONE/SODIUM CHLORIDE SOLN,OPH |
| 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 |
ARTIFICIAL TEARS PVA 1.4%/POVIDONE (PF) |
| VA PRODUCT IDENTIFIER |
P0971 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
0.4ML EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4009170 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
