BUPROPION 90MG/NALTREXONE HCL 8MG TAB,SA (26307) VA PRODUCT (50.68)

Name	Value
NAME	BUPROPION 90MG/NALTREXONE HCL 8MG TAB,SA
VA GENERIC NAME	BUPROPION/NALTREXONE
DOSAGE FORM	TAB,SA
FDA MED GUIDE	Bupropion-Naltrexone_(Contrave)_(2021).pdf
FORMULARY DESIGNATOR	PA-F
ACTIVE INGREDIENTS	NALTREXONE HYDROCHLORIDE STRENGTH: 8 UNITS: MG BUPROPION STRENGTH: 90 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	BUPROPION/NALTREXONE TAB,SA
CREATE DEFAULT POSSIBLE DOSAGE	YES
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	BUPROPION 90MG/NALTREXONE HCL 8MG SA TAB
VA PRODUCT IDENTIFIER	B0782
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4035110
EFFECTIVE DATE/TIME	2015-11-23 00:00:00 STATUS: ACTIVE