| NAME |
NALTREXONE (EQV-VIVITROL) 380MG/VIL INJ,SUSP,SA |
| VA GENERIC NAME |
NALTREXONE |
| DOSAGE FORM |
INJ,SUSP,SA |
| FDA MED GUIDE |
Naltrexone_(Vivitrol)_(2021).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
380 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/VIAL |
| NATIONAL FORMULARY NAME |
NALTREXONE INJ,SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
NALTREXONE(EQV-VIVITROL)380MG/VIL SA INJ |
| VA PRODUCT IDENTIFIER |
N0715 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034566 |
| EFFECTIVE DATE/TIME |
-
- 2015-06-30 00:00:00
- STATUS: ACTIVE
|
