EMTRICITABINE 200MG/RILPIVIRINE 25MG/TENOFOVIR 300MG TAB (22634) VA PRODUCT (50.68)

Name	Value
NAME	EMTRICITABINE 200MG/RILPIVIRINE 25MG/TENOFOVIR 300MG TAB
VA GENERIC NAME	EMTRICITABINE/RILPIVIRINE/TENOFOVIR
DOSAGE FORM	TAB
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to HIV/ID (or facility designated/authorized provider)
ACTIVE INGREDIENTS	TENOFOVIR DISOPROXIL FUMARATE STRENGTH: 300 UNITS: MG EMTRICITABINE STRENGTH: 200 UNITS: MG RILPIVIRINE HYDROCHLORIDE STRENGTH: 27.5 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	EMTRICITABINE/RILPIVIRINE/TENOFOVIR TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
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	COMPLERA TAB
VA PRODUCT IDENTIFIER	E0566
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4030952
EFFECTIVE DATE/TIME	2011-09-12 00:00:00 STATUS: ACTIVE