| NAME |
EMTRICITABINE 200MG/TENOFOVIR DISOPROXIL FUMARATE 300MG TAB |
| VA GENERIC NAME |
EMTRICITABINE/TENOFOVIR |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Emtricitabine_Tenofovir-TDF_(Generic)_(2021).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to ID (HIV/HBV) or GI, Oncology, Rheumatology for HBV or other providers for PrEP
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
EMTRICITABINE/TENOFOVIR TAB |
| 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: 2020-10-15 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-10-16 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
EMTRICITABINE 200MG/TENOFOVIR 300MG TAB |
| VA PRODUCT IDENTIFIER |
E0385 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4017222 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
