INDINAVIR SULFATE 400MG CAP (12536)    VA PRODUCT (50.68)

Name Value
NAME INDINAVIR SULFATE 400MG CAP
VA GENERIC NAME INDINAVIR
DOSAGE FORM CAP,ORAL
FORMULARY DESIGNATOR TEXT
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR NO
NATIONAL FORMULARY RESTRICTION 
Refer to HIV/AIDS TAG treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 400
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2020-12-15 00:00:00
UNITS MG
DSS NUMBER 1
NATIONAL FORMULARY NAME INDINAVIR CAP,ORAL
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE 1x Possible Dosage
PACKAGE Both Inpatient and Outpatient
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME INDINAVIR SULFATE 400MG CAP
VA PRODUCT IDENTIFIER I0192
TRANSMIT TO CMOP NO
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4012901
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE
  • 2020-12-15 00:00:00
    STATUS:   INACTIVE