| NAME |
ROTAVIRUS VACCINE,LIVE ATTENUATED,89-12 SUSP,ORAL |
| VA GENERIC NAME |
ROTAVIRUS |
| DOSAGE FORM |
SUSP,ORAL |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
ROTAVIRUS SUSP,ORAL |
| 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 |
ROTAVIRUS VAC,LIVE ATT,89-12 ORAL SUSP |
| VA PRODUCT IDENTIFIER |
R0343 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034560 |
| EFFECTIVE DATE/TIME |
-
- 2015-06-26 00:00:00
- STATUS: ACTIVE
|
