| NAME |
FOMEPIZOLE 1GM/ML INJ |
| VA GENERIC NAME |
FOMEPIZOLE |
| DOSAGE FORM |
INJ |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
GM/ML |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
FOMEPIZOLE INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
FOMEPIZOLE 1GM/ML INJ |
| VA PRODUCT IDENTIFIER |
F0168 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4013167 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
