OMBITASVIR 12.5/PARITAPREVIR 75/RITONAVIR 50MG TAB DAILY PACK (26256) VA PRODUCT (50.68)

Name	Value
NAME	OMBITASVIR 12.5/PARITAPREVIR 75/RITONAVIR 50MG TAB DAILY PACK
VA GENERIC NAME	OMBITASVIR/PARITAPREVIR/RITONAVIR
DOSAGE FORM	TAB
FDA MED GUIDE	Ombitasvir-Paritaprevir-Ritonavir_(Technivie)_(2019).pdf
FORMULARY DESIGNATOR	PA-F
ACTIVE INGREDIENTS	RITONAVIR STRENGTH: 50 UNITS: MG OMBITASVIR STRENGTH: 12.5 UNITS: MG PARITAPREVIR STRENGTH: 75 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2019-06-18 00:00:00
NATIONAL FORMULARY NAME	OMBITASVIR/PARITAPREVIR/RITONAVIR TAB
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	No Possible Dosages
CODING SYSTEM	RxNorm CODE:
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 DAILY PACK
VA PRODUCT IDENTIFIER	T0909
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKG
MASTER ENTRY FOR VUID	YES
VUID	4035054
EFFECTIVE DATE/TIME	2015-11-17 00:00:00 STATUS: ACTIVE 2019-06-18 00:00:00 STATUS: INACTIVE 2019-06-18 00:00:00 STATUS: INACTIVE