| NAME |
ROFLUMILAST 250MCG TAB |
| VA GENERIC NAME |
ROFLUMILAST |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Roflumilast_(Daliresp)_(2013).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
250 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MCG |
| NATIONAL FORMULARY NAME |
ROFLUMILAST TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-05-01 00:00:00
- COPAY END DATE: 2022-11-06 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-11-07 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ROFLUMILAST 250MCG TAB |
| VA PRODUCT IDENTIFIER |
R0374 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037388 |
| EFFECTIVE DATE/TIME |
-
- 2018-03-26 00:00:00
- STATUS: ACTIVE
|
