| NAME |
DIPHTHERIA/HAEMOPHILUS/PERTUSSIS/POLIO/TETANUS (PENTACEL) |
| VA GENERIC NAME |
DIPHTHERIA/HAEMOPHILUS/PERTUSSIS/POLIO/TETANUS |
| DOSAGE FORM |
INJ,SUSP |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
DIPHTHERIA/HAEMOPHILUS/PERTUSSIS/POLIO/TETANUS INJ,SUSP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
PENTACEL VACCINE |
| VA PRODUCT IDENTIFIER |
P1143 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034558 |
| EFFECTIVE DATE/TIME |
-
- 2015-06-26 00:00:00
- STATUS: ACTIVE
|
