| NAME |
SAPROPTERIN DIHYDROCHLORIDE 100MG/PKT PWDR,ORAL |
| VA GENERIC NAME |
SAPROPTERIN |
| DOSAGE FORM |
POWDER,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
100 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/PKT |
| NATIONAL FORMULARY NAME |
SAPROPTERIN POWDER,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
- COPAY END DATE: 2020-09-21 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-09-22 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SAPROPTERIN 100MG/PKT ORAL PWDR |
| VA PRODUCT IDENTIFIER |
S0729 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033152 |
| EFFECTIVE DATE/TIME |
-
- 2014-03-13 00:00:00
- STATUS: ACTIVE
|
