| NAME |
MAFENIDE ACETATE 50GM/PKT PWDR,TOP |
| VA GENERIC NAME |
MAFENIDE |
| DOSAGE FORM |
PWDR,RENST-TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
GM/PKT |
| NATIONAL FORMULARY NAME |
MAFENIDE PWDR,RENST-TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2017-11-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-12-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
MAFENIDE ACETATE 50GM/PKT TOP PWDR |
| VA PRODUCT IDENTIFIER |
M0459 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4013751 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
