EMTRICITABINE 200MG/RILPIVIRINE 25MG/TENOFOVIR 25MG TAB (26646) VA PRODUCT (50.68)

Name	Value
NAME	EMTRICITABINE 200MG/RILPIVIRINE 25MG/TENOFOVIR 25MG TAB
VA GENERIC NAME	EMTRICITABINE/RILPIVIRINE/TENOFOVIR
DOSAGE FORM	TAB
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to HIV/ID (or facility designated/authorized provider)
ACTIVE INGREDIENTS	EMTRICITABINE STRENGTH: 200 UNITS: MG RILPIVIRINE HYDROCHLORIDE STRENGTH: 27.5 UNITS: MG TENOFOVIR ALAFENAMIDE FUMARATE STRENGTH: 28 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	EMTRICITABINE/RILPIVIRINE/TENOFOVIR TAB
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	ODEFSEY TAB
VA PRODUCT IDENTIFIER	O0373
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4035482
EFFECTIVE DATE/TIME	2016-03-11 00:00:00 STATUS: ACTIVE