| NAME |
EDARAVONE 0.3MG/ML INJ,BAG,100ML |
| VA GENERIC NAME |
EDARAVONE |
| DOSAGE FORM |
INJ,SOLN |
| FORMULARY DESIGNATOR |
PA-N |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
0.3 |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
EDARAVONE INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-07-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
EDARAVONE 0.3MG/ML INJ BAG 100ML |
| VA PRODUCT IDENTIFIER |
E0712 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
BAG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036714 |
| EFFECTIVE DATE/TIME |
-
- 2017-06-01 00:00:00
- STATUS: ACTIVE
|
