| NAME |
ERAVACYCLINE 50MG/VIAL INJ |
| VA GENERIC NAME |
ERAVACYCLINE |
| DOSAGE FORM |
INJ,LYPHL |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to Infectious Diseases or other facility authorized provider
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/VIAL |
| NATIONAL FORMULARY NAME |
ERAVACYCLINE INJ,LYPHL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-10-04 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ERAVACYCLINE 50MG/VIAL INJ |
| VA PRODUCT IDENTIFIER |
E0759 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037882 |
| EFFECTIVE DATE/TIME |
-
- 2018-10-05 00:00:00
- STATUS: ACTIVE
|
