| NAME |
INCOBOTULINUMTOXINA 50 UNIT/VIL INJ |
| VA GENERIC NAME |
INCOBOTULINUMTOXINA |
| DOSAGE FORM |
INJ,LYPHL |
| FDA MED GUIDE |
Incobotulinumtoxin_A_(Xeomin)_(Dec_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 |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
UNIT/VIL |
| NATIONAL FORMULARY NAME |
INCOBOTULINUMTOXINA INJ,LYPHL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
INCOBOTULINUMTOXINA 50 UNIT/VIL INJ |
| VA PRODUCT IDENTIFIER |
I0512 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4030067 |
| EFFECTIVE DATE/TIME |
-
- 2010-09-08 00:00:00
- STATUS: ACTIVE
|
