| NAME |
EVEROLIMUS 1MG TAB |
| VA GENERIC NAME |
EVEROLIMUS |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Everolimus_(Zortress)_(2021).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restriction to Oncology, Neurology, Nephrology and Gastroenterology
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
EVEROLIMUS TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-11-01 00:00:00
- COPAY END DATE: 2021-12-01 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-12-02 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
EVEROLIMUS 1MG TAB |
| VA PRODUCT IDENTIFIER |
E0763 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037948 |
| EFFECTIVE DATE/TIME |
-
- 2018-11-01 00:00:00
- STATUS: ACTIVE
|
