| NAME |
INGENOL MEBUTATE 0.05% GEL,TOP |
| VA GENERIC NAME |
INGENOL |
| DOSAGE FORM |
GEL,TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.05 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
INGENOL GEL,TOP |
| 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: 2021-12-15 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-12-16 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
INGENOL MEBUTATE 0.05% TOP GEL |
| VA PRODUCT IDENTIFIER |
I0526 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TUBE |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031345 |
| EFFECTIVE DATE/TIME |
-
- 2012-04-06 00:00:00
- STATUS: ACTIVE
|
