| NAME |
ICOSAPENT ETHYL 1GM CAP |
| VA GENERIC NAME |
ICOSAPENT ETHYL |
| DOSAGE FORM |
CAP,ORAL |
| ACTIVE INGREDIENTS |
|
| STRENGTH |
1 |
| UNITS |
GM |
| NATIONAL FORMULARY NAME |
ICOSAPENT ETHYL CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2020-11-12 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-11-13 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ICOSAPENT ETHYL 1GM CAP |
| VA PRODUCT IDENTIFIER |
I0535 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032045 |
| EFFECTIVE DATE/TIME |
-
- 2013-01-31 00:00:00
- STATUS: ACTIVE
|
