DORAVIRINE 100MG/LAMIVUDINE 300MG/TENOFOVIR DF 300MG TAB (28785) VA PRODUCT (50.68)

Name	Value
NAME	DORAVIRINE 100MG/LAMIVUDINE 300MG/TENOFOVIR DF 300MG TAB
VA GENERIC NAME	DORAVIRINE/LAMIVUDINE/TENOFOVIR
DOSAGE FORM	TAB,ORAL
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to HIV/ID or other authorized facility providers
ACTIVE INGREDIENTS	LAMIVUDINE STRENGTH: 300 UNITS: MG TENOFOVIR DISOPROXIL FUMARATE STRENGTH: 300 UNITS: MG DORAVIRINE STRENGTH: 100 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	DORAVIRINE/LAMIVUDINE/TENOFOVIR TAB,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	1x Possible Dosage
PACKAGE	Both Inpatient and Outpatient
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2018-09-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	DORAVIRINE 100/LAMIV 300/TENOF 300MG TAB
VA PRODUCT IDENTIFIER	D1190
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4037851
EFFECTIVE DATE/TIME	2018-09-27 00:00:00 STATUS: ACTIVE