| NAME |
GLYCEROL PHENYLBUTYRATE 1.1GM/ML LIQUID,ORAL,25ML |
| VA GENERIC NAME |
GLYCEROL PHENYLBUTYRATE |
| DOSAGE FORM |
LIQUID,ORAL |
| FDA MED GUIDE |
Glycerol_Phenylbutyrate_(Ravicti)_(2021).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1.1 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
GM/ML |
| NATIONAL FORMULARY NAME |
GLYCEROL PHENYLBUTYRATE LIQUID,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
GLYCEROL PHENYLBUTYATE 1.1GM/ML LIQ 25ML |
| VA PRODUCT IDENTIFIER |
G0382 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032180 |
| EFFECTIVE DATE/TIME |
-
- 2013-02-28 00:00:00
- STATUS: ACTIVE
|
