| NAME |
BISMUTH 140MG/METRONIDAZOLE 125MG/TETRACYCLINE 125MG CAP,ORAL |
| VA GENERIC NAME |
BISMUTH/METRONIDAZOLE/TETRACYCLINE |
| DOSAGE FORM |
CAP,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
BISMUTH/METRONIDAZOLE/TETRACYCLINE CAP,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: 2023-03-15 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-03-16 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
PYLERA ORAL CAP |
| VA PRODUCT IDENTIFIER |
B0570 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4026131 |
| EFFECTIVE DATE/TIME |
-
- 2007-06-19 00:00:00
- STATUS: ACTIVE
|
