| NAME |
DESVENLAFAXINE (EQV-PRISTIQ) 25MG TAB,SA |
| VA GENERIC NAME |
DESVENLAFAXINE |
| DOSAGE FORM |
TAB,SA |
| FDA MED GUIDE |
Desvenlafaxine_XR_(Generic)_(2021).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
25 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DESVENLAFAXINE TAB,SA |
| 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: 2017-04-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-05-01 00:00:00
|
| PGX ELIGIBLE |
YES |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DESVENLAFAXINE (EQV-PRISTIQ) 25MG SA TAB |
| VA PRODUCT IDENTIFIER |
D1088 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034354 |
| EFFECTIVE DATE/TIME |
-
- 2015-04-13 00:00:00
- STATUS: ACTIVE
|
