| NAME |
POSACONAZOLE 200MG/5ML SUSP,ORAL |
| VA GENERIC NAME |
POSACONAZOLE |
| DOSAGE FORM |
SUSP,ORAL |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to ID/Hematology/Oncology or other facility authorized providers
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
200 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/5ML |
| NATIONAL FORMULARY NAME |
POSACONAZOLE SUSP,ORAL |
| 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: 2019-08-14 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-08-15 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
POSACONAZOLE 200MG/5ML ORAL SUSP |
| VA PRODUCT IDENTIFIER |
P0763 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4025621 |
| EFFECTIVE DATE/TIME |
-
- 2006-10-11 00:00:00
- STATUS: ACTIVE
|
