| NAME |
DOLUTEGRAVIR 5MG TAB,SUSP,ORAL |
| VA GENERIC NAME |
DOLUTEGRAVIR |
| DOSAGE FORM |
TAB,SUSP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR TEXT |
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
5 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DOLUTEGRAVIR TAB,SUSP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2020-06-25 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DOLUTEGRAVIR 5MG SUSP TAB |
| VA PRODUCT IDENTIFIER |
D1241 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4039482 |
| EFFECTIVE DATE/TIME |
-
- 2020-06-25 00:00:00
- STATUS: ACTIVE
|
