FIBRINOGEN 79MG/THROMBIN 699UNT/GM PWDR,TOP,1GM (27295) VA PRODUCT (50.68)

Name	Value
NAME	FIBRINOGEN 79MG/THROMBIN 699UNT/GM PWDR,TOP,1GM
VA GENERIC NAME	FIBRINOGEN/THROMBIN
DOSAGE FORM	POWDER,TOP
ACTIVE INGREDIENTS	THROMBIN STRENGTH: 699 UNITS: UNIT/GM FIBRINOGEN STRENGTH: 79 UNITS: MG/GM
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2018-11-15 00:00:00
NATIONAL FORMULARY NAME	FIBRINOGEN/THROMBIN POWDER,TOP
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	RAPLIXA 79MG/699UNT/GM TOP PWDR 1GM
VA PRODUCT IDENTIFIER	R0355
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	VI
MASTER ENTRY FOR VUID	YES
VUID	4036192
EFFECTIVE DATE/TIME	2016-11-23 00:00:00 STATUS: ACTIVE 2018-11-15 00:00:00 STATUS: INACTIVE