| NAME |
ULTRA-KLENZ,WOUND CLEANSER |
| VA GENERIC NAME |
ULTRA-KLENZ |
| DOSAGE FORM |
LIQUID,TOP |
| FORMULARY DESIGNATOR TEXT |
Not supplied by pharmacy for inpatient use.
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2012-09-06 00:00:00 |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
ULTRA-KLENZ LIQUID,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2017-05-31 00:00:00
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-06-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ULTRA-KLENZ WOUND CLEANSER |
| VA PRODUCT IDENTIFIER |
XX443 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4010373 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2012-09-06 00:00:00
- STATUS: INACTIVE
|
