LEDIPASVIR 45MG/SOFOSBUVIR 200MG/PKT PELLET,ORAL (30171) VA PRODUCT (50.68)

Name	Value
NAME	LEDIPASVIR 45MG/SOFOSBUVIR 200MG/PKT PELLET,ORAL
VA GENERIC NAME	LEDIPASVIR/SOFOSBUVIR
DOSAGE FORM	PELLET
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	SOFOSBUVIR STRENGTH: 200 UNITS: MG/PKT LEDIPASVIR STRENGTH: 45 UNITS: MG/PKT
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	LEDIPASVIR/SOFOSBUVIR PELLET
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	No Possible Dosages
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2020-06-04 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	HARVONI 45MG/200MG/PKT ORAL PELLET
VA PRODUCT IDENTIFIER	H0751
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKT
MASTER ENTRY FOR VUID	YES
VUID	4039428
EFFECTIVE DATE/TIME	2020-06-04 00:00:00 STATUS: ACTIVE