| NAME |
DABIGATRAN ETEXILATE 75MG CAP,ORAL |
| VA GENERIC NAME |
DABIGATRAN |
| DOSAGE FORM |
CAP,ORAL |
| FDA MED GUIDE |
Dabigatran_(Pradaxa)_(Jun_2021).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
75 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DABIGATRAN 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: 2022-07-06 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-07-07 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DABIGATRAN ETEXILATE 75MG ORAL CAP |
| VA PRODUCT IDENTIFIER |
D0868 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4030250 |
| EFFECTIVE DATE/TIME |
-
- 2010-11-09 00:00:00
- STATUS: ACTIVE
|
