| NAME |
OMBITASVIR 12.5/PARITAPREVIR 75/RITONAVIR 50MG TAB DOSE PACK,56 |
| VA GENERIC NAME |
OMBITASVIR/PARITAPREVIR/RITONAVIR |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Ombitasvir-Paritaprevir-Ritonavir_(Technivie)_(2019).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2016-01-26 00:00:00 |
| NATIONAL FORMULARY NAME |
OMBITASVIR/PARITAPREVIR/RITONAVIR TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
TECHNIVIE DOSE PACK,56 |
| VA PRODUCT IDENTIFIER |
T0895 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034711 |
| EFFECTIVE DATE/TIME |
-
- 2015-08-14 00:00:00
- STATUS: ACTIVE
|
