| NAME |
FOLLITROPIN BETA (FOLLISTIM) PEN DEVICE |
| VA GENERIC NAME |
FOLLITROPIN |
| DOSAGE FORM |
DEVICE |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
FOLLITROPIN DEVICE |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-05-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
FOLLITROPIN BETA (FOLLISTIM) PEN DEVICE |
| VA PRODUCT IDENTIFIER |
XI896 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036512 |
| EFFECTIVE DATE/TIME |
-
- 2017-03-24 00:00:00
- STATUS: ACTIVE
|
