| NAME |
MITOMYCIN 40MG/VIL INJ |
| VA GENERIC NAME |
MITOMYCIN |
| DOSAGE FORM |
INJ |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restrict to Hematology/Oncology
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
40 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/VIAL |
| NATIONAL FORMULARY NAME |
MITOMYCIN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-05-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
MITOMYCIN 40MG/VIL INJ |
| VA PRODUCT IDENTIFIER |
M1161 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036540 |
| EFFECTIVE DATE/TIME |
-
- 2017-04-04 00:00:00
- STATUS: ACTIVE
|
