BALOXAVIR MARBOXIL 40MG TAB (28875)    VA PRODUCT (50.68)

Name Value
NAME BALOXAVIR MARBOXIL 40MG TAB
VA GENERIC NAME BALOXAVIR
DOSAGE FORM TAB,ORAL
FORMULARY DESIGNATOR PA-F
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 40
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG
NATIONAL FORMULARY NAME BALOXAVIR TAB,ORAL
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2018-11-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BALOXAVIR MARBOXIL 40MG TAB
VA PRODUCT IDENTIFIER B0876
TRANSMIT TO CMOP NO
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4037955
EFFECTIVE DATE/TIME
  • 2018-11-01 00:00:00
    STATUS:   ACTIVE