TESTOSTERONE (ANDROGEL) 1.62% 1.25GM/PKT GEL,TOP (24417)    VA PRODUCT (50.68)

Name Value
NAME TESTOSTERONE (ANDROGEL) 1.62% 1.25GM/PKT GEL,TOP
VA GENERIC NAME TESTOSTERONE
DOSAGE FORM GEL,TOP
FDA MED GUIDE Testosterone_Gel_(Generic)_(2021).pdf
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Schedule III Non-Narcotics
STRENGTH 1.62
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2019-08-15 00:00:00
UNITS %
NATIONAL FORMULARY NAME TESTOSTERONE GEL,TOP
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME TESTOSTERONE (ANDROGEL) 1.62% 1.25GM/PKT
VA PRODUCT IDENTIFIER T0844
TRANSMIT TO CMOP YES
VA DISPENSE UNIT PKT
MASTER ENTRY FOR VUID YES
VUID 4032991
EFFECTIVE DATE/TIME
  • 2014-01-22 00:00:00
    STATUS:   ACTIVE
  • 2019-08-15 00:00:00
    STATUS:   INACTIVE
  • 2019-08-15 00:00:00
    STATUS:   INACTIVE