CALCIUM/MAGNESIUM/POTASSIUM/SODIUM OXYBATE 500MG/ML SOLN,ORAL (30449) VA PRODUCT (50.68)

Name	Value
NAME	CALCIUM/MAGNESIUM/POTASSIUM/SODIUM OXYBATE 500MG/ML SOLN,ORAL
VA GENERIC NAME	CALCIUM/MAGNESIUM/POTASSIUM/SODIUM OXYBATE
DOSAGE FORM	SOLN,ORAL
FDA MED GUIDE	Calcium-magnesium-potassium-sodium-oxybates_(Xywav)_(Aug_2021).pdf
HAZARDOUS TO DISPOSE	NO
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Prescribed and monitored by a VA/VA Community Care sleep specialist/pulmonologist/neurologist or locally designated expert in sleep disorders.
ACTIVE INGREDIENTS	SODIUM OXYBATE STRENGTH: 40 UNITS: MG/ML CALCIUM OXYBATE STRENGTH: 234 UNITS: MG/ML MAGNESIUM OXYBATE STRENGTH: 96 UNITS: MG/ML POTASSIUM OXYBATE STRENGTH: 130 UNITS: MG/ML
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Schedule III Non-Narcotics
STRENGTH	500
SINGLE/MULTI SOURCE PRODUCT	Single source
UNITS	MG/ML
NATIONAL FORMULARY NAME	CALCIUM/MAGNESIUM/POTASSIUM/SODIUM OXYBATE SOLN,ORAL
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: 2020-10-08 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	CA/MG/K/NA OXYBATE 500MG/ML ORAL SOLN
VA PRODUCT IDENTIFIER	C1960
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4039748
EFFECTIVE DATE/TIME	2020-10-08 00:00:00 STATUS: ACTIVE 2020-10-08 00:00:00 STATUS: ACTIVE 2020-10-08 00:00:00 STATUS: ACTIVE