| NAME |
ARIPIPRAZOLE LAUROXIL 1064MG/3.9ML INJ,SUSP,SA |
| VA GENERIC NAME |
ARIPIPRAZOLE |
| DOSAGE FORM |
INJ,SUSP,SA |
| FDA MED GUIDE |
Aripiprazole_Inj_(Aristada)_(2018).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1064 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/3.9ML |
| NATIONAL FORMULARY NAME |
ARIPIPRAZOLE INJ,SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-08-01 00:00:00
|
| PGX ELIGIBLE |
YES |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ARIPIPRAZOLE 1064MG/3.9ML SA INJ SUSP |
| VA PRODUCT IDENTIFIER |
A1938 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036734 |
| EFFECTIVE DATE/TIME |
-
- 2017-06-16 00:00:00
- STATUS: ACTIVE
|
