GONADOTROPIN,CHORIONIC 5000UNT/VIL INJ (1110)    VA PRODUCT (50.68)

Name Value
NAME GONADOTROPIN,CHORIONIC 5000UNT/VIL INJ
VA GENERIC NAME GONADOTROPIN,CHORIONIC
DOSAGE FORM INJ
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to non-VA infertility referral/VA infertility Specialist
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 5000
UNITS UNT/VIL
DSS NUMBER 5
NATIONAL FORMULARY NAME GONADOTROPIN,CHORIONIC INJ
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME GONADOTROPIN,CHORIONIC 5000UNT/VIL INJ
VA PRODUCT IDENTIFIER G0448
TRANSMIT TO CMOP NO
VA DISPENSE UNIT VI
MASTER ENTRY FOR VUID YES
VUID 4001712
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-28 00:00:00
    STATUS:   INACTIVE
  • 2017-10-13 00:00:00
    STATUS:   ACTIVE