| NAME |
MILTEFOSINE 50MG CAP |
| VA GENERIC NAME |
MILTEFOSINE |
| DOSAGE FORM |
CAP,ORAL |
| FDA MED GUIDE |
Miltefosine_(Impavido)_(2021).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
MILTEFOSINE CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| 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 |
MILTEFOSINE 50MG CAP |
| VA PRODUCT IDENTIFIER |
M1138 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035637 |
| EFFECTIVE DATE/TIME |
-
- 2016-04-22 00:00:00
- STATUS: ACTIVE
|
