| NAME |
GILTERITINIB 40MG TAB |
| VA GENERIC NAME |
GILTERITINIB |
| DOSAGE FORM |
TAB,ORAL |
| FDA MED GUIDE |
Gilteritinib_(Xospata)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
40 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
GILTERITINIB TAB,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-12-06 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
GILTERITINIB 40MG TAB |
| VA PRODUCT IDENTIFIER |
G0461 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038037 |
| EFFECTIVE DATE/TIME |
-
- 2018-12-06 00:00:00
- STATUS: ACTIVE
|
