| NAME |
PIPERACILLIN NA 12GM/TAZOBACTAM NA 1.5GM/VIL INJ |
| VA GENERIC NAME |
PIPERACILLIN/TAZOBACTAM |
| DOSAGE FORM |
INJ |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
PIPERACILLIN/TAZOBACTAM INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 1
- COPAY EFFECTIVE DATE: 2017-04-01 00:00:00
- COPAY END DATE: 2017-04-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-05-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
PIPERACILLIN 12/TAZOBACTAM 1.5GM/VIL INJ |
| VA PRODUCT IDENTIFIER |
P1185 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036398 |
| EFFECTIVE DATE/TIME |
-
- 2017-02-09 00:00:00
- STATUS: ACTIVE
|
