CILASTATIN NA 500MG/IMIPENEM 500MG/RELEBACTAM 250MG VIL INJ IV (29855) VA PRODUCT (50.68)

Name	Value
NAME	CILASTATIN NA 500MG/IMIPENEM 500MG/RELEBACTAM 250MG VIL INJ IV
VA GENERIC NAME	CILASTATIN/IMIPENEN/RELEBACTAM
DOSAGE FORM	INJ,PWDR
HAZARDOUS TO DISPOSE	NO
FORMULARY DESIGNATOR TEXT	Restricted to ID or other facility authorized providers
ACTIVE INGREDIENTS	RELEBACTAM STRENGTH: 250 CILASTATIN SODIUM STRENGTH: 500 IMIPENEM STRENGTH: 500
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	CILASTATIN/IMIPENEN/RELEBACTAM INJ,PWDR
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2020-01-16 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	CILASTATIN/IMIPEN/RELEBACT 1.25GM INJ VI
VA PRODUCT IDENTIFIER	C1912
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	VI
MASTER ENTRY FOR VUID	YES
VUID	4039071
EFFECTIVE DATE/TIME	2020-01-16 00:00:00 STATUS: ACTIVE