DASABUVIR/OMBITASVIR/PARITAPREVIR/RITONAVIR DAILY DOSE PACK (25326) VA PRODUCT (50.68)

Name	Value
NAME	DASABUVIR/OMBITASVIR/PARITAPREVIR/RITONAVIR DAILY DOSE PACK
VA GENERIC NAME	DASABUVIR/OMBITASVIR/PARITAPREVIR/RITONAVIR
DOSAGE FORM	TAB
FDA MED GUIDE	Ombitasvir-Paritaprevir-Ritonavir_and_Dasabuvir_(Viekira_Pak)_(2019).pdf
FORMULARY DESIGNATOR	R
ACTIVE INGREDIENTS	RITONAVIR STRENGTH: 50 UNITS: MG OMBITASVIR STRENGTH: 12.5 UNITS: MG PARITAPREVIR STRENGTH: 75 UNITS: MG DASABUVIR STRENGTH: 250 UNITS: MG
NATIONAL FORMULARY INDICATOR	NO
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	DASABUVIR/OMBITASVIR/PARITAPREVIR/RITONAVIR TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	VIEKIRA DAILY PAK
VA PRODUCT IDENTIFIER	V0260
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKG
MASTER ENTRY FOR VUID	YES
VUID	4034030
EFFECTIVE DATE/TIME	2015-01-06 00:00:00 STATUS: ACTIVE