| NAME |
BACLOFEN 1MG/ML (PF) INJ,INTRATHECAL,AMP,20ML |
| VA GENERIC NAME |
BACLOFEN |
| DOSAGE FORM |
INJ |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
BACLOFEN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-05-01 00:00:00
- COPAY END DATE: 2019-03-06 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-03-07 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BACLOFEN 1MG/ML PF INTRATHECAL AMP 20ML |
| VA PRODUCT IDENTIFIER |
B0859 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037412 |
| EFFECTIVE DATE/TIME |
-
- 2018-03-29 00:00:00
- STATUS: ACTIVE
|
