| NAME |
ISAVUCONAZONIUM SULFATE 186MG CAP,ORAL |
| VA GENERIC NAME |
ISAVUCONAZONIUM SULFATE |
| DOSAGE FORM |
CAP,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
186 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
ISAVUCONAZONIUM SULFATE CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x and 2x Possible Dosages |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ISAVUCONAZONIUM SULFATE 186MG ORAL CAP |
| VA PRODUCT IDENTIFIER |
I0593 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034332 |
| EFFECTIVE DATE/TIME |
-
- 2015-04-02 00:00:00
- STATUS: ACTIVE
|
