COBICISTAT/ELVITEGRAVIR/EMTRICITABINE/TENOFOVIR DF TAB,ORAL (23233) VA PRODUCT (50.68)

Name	Value
NAME	COBICISTAT/ELVITEGRAVIR/EMTRICITABINE/TENOFOVIR DF TAB,ORAL
VA GENERIC NAME	COBICISTAT/ELVITEGRAVIR/EMTRICITABINE/TENOFOVIR
DOSAGE FORM	TAB,ORAL
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 COBICISTAT STRENGTH: 150 UNITS: MG ELVITEGRAVIR STRENGTH: 150 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	COBICISTAT/ELVITEGRAVIR/EMTRICITABINE/TENOFOVIR TAB,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	No Possible Dosages
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	STRIBILD ORAL TAB
VA PRODUCT IDENTIFIER	C1522
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4031658
EFFECTIVE DATE/TIME	2012-09-10 00:00:00 STATUS: ACTIVE