| NAME |
DIPHTH,HEP-B,PERTUSS,POLIO,TET VACCINE (PEDIARIX) 0.5ML SYR |
| VA GENERIC NAME |
DIPHTHERIA/HEPATITIS B/PERTUSSIS/POLIO/TETANUS |
| DOSAGE FORM |
INJ,SUSP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
DIPHTHERIA/HEPATITIS B/PERTUSSIS/POLIO/TETANUS INJ,SUSP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DIP/HEP-B/PERTUS/POLIO/TET(PEDIARIX) SYR |
| VA PRODUCT IDENTIFIER |
D1059 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033766 |
| EFFECTIVE DATE/TIME |
-
- 2014-10-17 00:00:00
- STATUS: ACTIVE
|
