| NAME |
ELTROMBOPAG 12.5MG TAB |
| VA GENERIC NAME |
ELTROMBOPAG |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Eltrombopag_(Promacta)_(2023).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
12.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
ELTROMBOPAG TAB |
| 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 |
ELTROMBOPAG 12.5MG TAB |
| VA PRODUCT IDENTIFIER |
E0580 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031441 |
| EFFECTIVE DATE/TIME |
-
- 2012-06-11 00:00:00
- STATUS: ACTIVE
|
