| NAME |
ACALABRUTINIB 100MG CAP,ORAL |
| VA GENERIC NAME |
ACALABRUTINIB |
| DOSAGE FORM |
CAP,ORAL |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
100 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2023-05-15 00:00:00 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
ACALABRUTINIB CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-01-01 00:00:00
- COPAY END DATE: 2023-02-01 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-02-02 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ACALABRUTINIB 100MG ORAL CAP |
| VA PRODUCT IDENTIFIER |
A1958 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037066 |
| EFFECTIVE DATE/TIME |
-
- 2017-11-20 00:00:00
- STATUS: ACTIVE
-
- 2023-05-15 00:00:00
- STATUS: INACTIVE
|
