| NAME |
DOXYCYCLINE HYCLATE 75MG TAB |
| VA GENERIC NAME |
DOXYCYCLINE |
| DOSAGE FORM |
TAB |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
75 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DOXYCYCLINE TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2019-10-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-10-31 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DOXYCYCLINE HYCLATE 75MG TAB |
| VA PRODUCT IDENTIFIER |
D1028 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033570 |
| EFFECTIVE DATE/TIME |
-
- 2014-08-14 00:00:00
- STATUS: ACTIVE
-
- 2020-01-09 00:00:00
- STATUS: ACTIVE
|
