| NAME |
ALPROSTADIL 125MCG SUPP,URETHRAL |
| VA GENERIC NAME |
ALPROSTADIL |
| DOSAGE FORM |
SUPPOSITORY |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
125 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MCG |
| DSS NUMBER |
5 |
| NATIONAL FORMULARY NAME |
ALPROSTADIL SUPPOSITORY |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2021-06-23 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-06-24 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ALPROSTADIL 125MCG URETHRAL SUPP |
| VA PRODUCT IDENTIFIER |
A0744 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003537 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
