| NAME |
DOFETILIDE 125MCG CAP,UD |
| VA GENERIC NAME |
DOFETILIDE |
| DOSAGE FORM |
CAP,ORAL |
| FDA MED GUIDE |
Dofetilide_(Generic)_(2018).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
125 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MCG |
| NATIONAL FORMULARY NAME |
DOFETILIDE CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Inpatient |
| 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 |
DOFETILIDE 125MCG UD CAP |
| VA PRODUCT IDENTIFIER |
D0510 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4014671 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
