| NAME |
CEFTAZIDIME 2GM/AVIBACTAM 0.5GM/VIAL INJ |
| VA GENERIC NAME |
AVIBACTAM/CEFTAZIDIME |
| DOSAGE FORM |
INJ |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
restricted to Infectious Diseases or facility authorized provider
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
AVIBACTAM/CEFTAZIDIME INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2020-06-28 00:00:00
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2020-06-29 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
CEFTAZIDIME 2GM/AVIBACTAM 0.5GM/VIAL INJ |
| VA PRODUCT IDENTIFIER |
C1707 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034430 |
| EFFECTIVE DATE/TIME |
-
- 2015-05-05 00:00:00
- STATUS: ACTIVE
|
