| NAME |
RILUZOLE 50MG/10ML SUSP,ORAL |
| VA GENERIC NAME |
RILUZOLE |
| DOSAGE FORM |
SUSP,ORAL |
| FORMULARY DESIGNATOR TEXT |
Restricted to neurology or locally designated subject matter expert for the treatment of ALS only.
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/10ML |
| NATIONAL FORMULARY NAME |
RILUZOLE SUSP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2018-10-18 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
RILUZOLE 50MG/10ML ORAL SUSP |
| VA PRODUCT IDENTIFIER |
R0383 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037924 |
| EFFECTIVE DATE/TIME |
-
- 2018-10-22 00:00:00
- STATUS: ACTIVE
|
