AMIFOSTINE 500MG/MANNITOL 500MG/VIL INJ (12542) VA PRODUCT (50.68)

Name	Value
NAME	AMIFOSTINE 500MG/MANNITOL 500MG/VIL INJ
VA GENERIC NAME	AMIFOSTINE/MANNITOL
DOSAGE FORM	INJ,LYPHL
ACTIVE INGREDIENTS	MANNITOL STRENGTH: 500 UNITS: MG/VIAL AMIFOSTINE STRENGTH: 500 UNITS: MG/VIAL
CS FEDERAL SCHEDULE	Unscheduled
STRENGTH	500
INACTIVATION DATE	2004-02-26 00:00:00
UNITS	MG/VIAL
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMIFOSTINE/MANNITOL INJ,LYPHL
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	AMIFOSTINE 500MG/MANNITOL 500MG/VIL INJ
VA PRODUCT IDENTIFIER	A0723
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	VI
MASTER ENTRY FOR VUID	YES
VUID	4012907
EFFECTIVE DATE/TIME	2004-02-26 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE