ABOBOTULINUMTOXINA 300 UNIT/VIL INJ (20750)    VA PRODUCT (50.68)

Name Value
NAME ABOBOTULINUMTOXINA 300 UNIT/VIL INJ
VA GENERIC NAME ABOBOTULINUMTOXINA
DOSAGE FORM INJ,LYPHL
FDA MED GUIDE Abobotulinumtoxin_A_(Dysport)_(2020).pdf
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
At least one of the agents must be marked formulary, discretion is left to VISN or Facility to determine which agent(s).
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 300
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS UNT/VIL
NATIONAL FORMULARY NAME ABOBOTULINUMTOXINA INJ,LYPHL
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME ABOBOTULINUMTOXINA 300 UNIT/VIL INJ
VA PRODUCT IDENTIFIER A1503
TRANSMIT TO CMOP NO
VA DISPENSE UNIT VI
MASTER ENTRY FOR VUID YES
VUID 4028816
EFFECTIVE DATE/TIME
  • 2009-08-11 00:00:00
    STATUS:   ACTIVE
  • 2010-02-04 00:00:00
    STATUS:   INACTIVE
  • 2011-09-12 00:00:00
    STATUS:   ACTIVE