| NAME |
TESTOSTERONE ENANTHATE (IN OIL) 100MG/0.5ML INJ,PEN,0.5ML |
| VA GENERIC NAME |
TESTOSTERONE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Testosterone_(Xyosted)_(2018).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Schedule III Non-Narcotics |
| STRENGTH |
100 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/0.5ML |
| NATIONAL FORMULARY NAME |
TESTOSTERONE INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2018-11-15 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TESTOSTERONE ENAN 100MG/0.5ML PEN 0.5ML |
| VA PRODUCT IDENTIFIER |
T1001 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
SYRINGE |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037988 |
| EFFECTIVE DATE/TIME |
-
- 2018-11-19 00:00:00
- STATUS: ACTIVE
|
