| NAME |
BOTULINUM TOXIN TYPE A 100UNT/VIL OPH |
| VA GENERIC NAME |
BOTULINUM TOXIN TYPE A |
| DOSAGE FORM |
INJ,PWDR |
| FORMULARY DESIGNATOR TEXT |
At least one of the agents must be marked formulary, discretion is left to VISN or Facility to determine which agent(s).
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
100 |
| INACTIVATION DATE |
2009-11-17 00:00:00 |
| UNITS |
UNT/VIL |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
BOTULINUM TOXIN TYPE A 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 |
BOTULINUM TOXIN TYPE A 100UNT/VIL OPH |
| VA PRODUCT IDENTIFIER |
B0495 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4010426 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2009-11-17 00:00:00
- STATUS: INACTIVE
|
