| NAME |
FLUTICASONE 200MCG/VILANTEROL 25MCG INHL,ORAL,14D |
| VA GENERIC NAME |
FLUTICASONE/VILANTEROL |
| DOSAGE FORM |
INHL,ORAL |
| FDA MED GUIDE |
Fluticasone-Vilanterol_(Breo_Ellipta)_(2017).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
FLUTICASONE/VILANTEROL INHL,ORAL |
| 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: 2022-06-01 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-06-02 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
FLUTIC 200/VILANTEROL 25MCG 14D ORAL INH |
| VA PRODUCT IDENTIFIER |
F0654 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
INHALER |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037397 |
| EFFECTIVE DATE/TIME |
-
- 2018-03-27 00:00:00
- STATUS: ACTIVE
|
