| NAME |
VANCOMYCIN HCL 4MG/ML/SODIUM CHLORIDE 0.9% INJ,BAG,250ML |
| VA GENERIC NAME |
VANCOMYCIN |
| DOSAGE FORM |
INJ |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
4 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
VANCOMYCIN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
VANCOMYCIN 4MG/ML/NACL INJ BAG 250ML |
| VA PRODUCT IDENTIFIER |
V0264 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
BAG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034424 |
| EFFECTIVE DATE/TIME |
-
- 2015-05-04 00:00:00
- STATUS: ACTIVE
|
