| NAME |
DIPHTHERIA/TETANUS TOXOIDS/PERTUSSIS VACCINE INJ |
| VA GENERIC NAME |
DIPHTHERIA TOXOID/PERTUSSIS VACCINE/TETANUS TOXOID |
| DOSAGE FORM |
INJ,SUSP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2023-02-15 00:00:00 |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
DIPHTHERIA TOXOID/PERTUSSIS VACCINE/TETANUS TOXOID INJ,SUSP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2019-11-15 00:00:00
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2019-11-16 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DIPHTHERIA/TETANUS/PERTUSSIS VACCINE INJ |
| VA PRODUCT IDENTIFIER |
D0713 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4002291 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2023-02-15 00:00:00
- STATUS: INACTIVE
|
