DALFOPRISTIN 350MG/QUINUPRISTIN 150MG/VIL INJ (13877)    VA PRODUCT (50.68)

Name Value
NAME DALFOPRISTIN 350MG/QUINUPRISTIN 150MG/VIL INJ
VA GENERIC NAME DALFOPRISTIN/QUINUPRISTIN
DOSAGE FORM INJ
FORMULARY DESIGNATOR R
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2022-12-15 00:00:00
NATIONAL FORMULARY NAME DALFOPRISTIN/QUINUPRISTIN INJ
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2022-09-07 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2022-09-08 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME DALFOPRISTIN 350/QUINUPRISTIN 150MG/VIL
VA PRODUCT IDENTIFIER D0516
TRANSMIT TO CMOP YES
VA DISPENSE UNIT VI
MASTER ENTRY FOR VUID YES
VUID 4014241
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-19 00:00:00
    STATUS:   INACTIVE
  • 2007-10-10 00:00:00
    STATUS:   ACTIVE
  • 2022-12-15 00:00:00
    STATUS:   INACTIVE