| NAME |
INSULIN,GLARGINE,HUMAN 100 UNIT/ML INJ,KWIKPEN,3ML |
| VA GENERIC NAME |
INSULIN |
| DOSAGE FORM |
INJ |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR TEXT |
VISNs may choose a preferred agent (glargine U-100 or detemir)
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
100 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
UNIT/ML |
| NATIONAL FORMULARY NAME |
INSULIN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2022-05-18 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-05-19 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
INSULIN,GLARGINE 100 UNT/ML 3ML KWIKPEN |
| VA PRODUCT IDENTIFIER |
I0622 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036330 |
| EFFECTIVE DATE/TIME |
-
- 2017-01-11 00:00:00
- STATUS: ACTIVE
|
