| NAME |
SODIUM OXYBATE 500MG/ML SOLN,ORAL |
| VA GENERIC NAME |
SODIUM OXYBATE |
| DOSAGE FORM |
SOLN,ORAL |
| FDA MED GUIDE |
Sodium_Oxybate_(Xyrem)_(Sep_2020).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| CS FEDERAL SCHEDULE |
Schedule III Non-Narcotics |
| STRENGTH |
500 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
SODIUM OXYBATE SOLN,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2022-12-28 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-12-29 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SODIUM OXYBATE 500MG/ML ORAL SOLN |
| VA PRODUCT IDENTIFIER |
S0397 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4016247 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
