| NAME |
INDOMETHACIN 50MG SUPP,RTL |
| VA GENERIC NAME |
INDOMETHACIN |
| DOSAGE FORM |
SUPP,RTL |
| FDA MED GUIDE |
NSAIDs_(Class)_(2022).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to patients having an ERCP procedure
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| DSS NUMBER |
3 |
| NATIONAL FORMULARY NAME |
INDOMETHACIN SUPP,RTL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
INDOMETHACIN 50MG RTL SUPP |
| VA PRODUCT IDENTIFIER |
I0022 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4002666 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
