COBICISTAT 150MG/DARUNAVIR 800MG TAB,ORAL (25429)    VA PRODUCT (50.68)

Name Value
NAME COBICISTAT 150MG/DARUNAVIR 800MG TAB,ORAL
VA GENERIC NAME COBICISTAT/DARUNAVIR
DOSAGE FORM TAB,ORAL
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to HIV/ID (or facility designated/authorized provider)
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME COBICISTAT/DARUNAVIR TAB,ORAL
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 COBICISTAT 150MG/DARUNAVIR 800MG TAB
VA PRODUCT IDENTIFIER C1693
TRANSMIT TO CMOP YES
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4034148
EFFECTIVE DATE/TIME
  • 2015-02-13 00:00:00
    STATUS:   ACTIVE