EMTRICITABINE 167MG/TENOFOVIR DISOPROXIL FUMARATE 250MG TAB (26889) VA PRODUCT (50.68)

Name	Value
NAME	EMTRICITABINE 167MG/TENOFOVIR DISOPROXIL FUMARATE 250MG TAB
VA GENERIC NAME	EMTRICITABINE/TENOFOVIR
DOSAGE FORM	TAB
FDA MED GUIDE	Emtricitabine_Tenofovir-TDF_(Generic)_(2021).pdf
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to ID (HIV/HBV) or GI, Oncology, Rheumatology for HBV or other providers for PrEP
ACTIVE INGREDIENTS	TENOFOVIR DISOPROXIL FUMARATE STRENGTH: 250 UNITS: MG EMTRICITABINE STRENGTH: 167 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	EMTRICITABINE/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 COPAY END DATE: 2021-01-27 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2021-01-28 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	EMTRICITABINE 167MG/TENOFOVIR 250MG TAB
VA PRODUCT IDENTIFIER	E0683
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4035744
EFFECTIVE DATE/TIME	2016-05-27 00:00:00 STATUS: ACTIVE