FLUTICASONE 200/UMECLIDINIUM 62.5/VILANTEROL 25MCG/ACTUAT INH,30 (30453) VA PRODUCT (50.68)

Name	Value
NAME	FLUTICASONE 200/UMECLIDINIUM 62.5/VILANTEROL 25MCG/ACTUAT INH,30
VA GENERIC NAME	FLUTICASONE/UMECLIDINIUM/VILANTEROL
DOSAGE FORM	INHL,ORAL
FDA MED GUIDE	Fluticasone-Umeclidinium-Vilanterol_(Trelegy_Ellipta)_(2017).pdf
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	FLUTICASONE FUROATE STRENGTH: 200 UNITS: MCG/INHL VILANTEROL STRENGTH: 25 UNITS: MCG/INHL UMECLIDINIUM STRENGTH: 62.5 UNITS: MCG/INHL
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	FLUTICASONE/UMECLIDINIUM/VILANTEROL INHL,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2020-10-16 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	TRELEGY ELLIPTA 200/62.5/25MCG INH 30D
VA PRODUCT IDENTIFIER	T1074
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	INHALER
MASTER ENTRY FOR VUID	YES
VUID	4039752
EFFECTIVE DATE/TIME	2020-10-16 00:00:00 STATUS: ACTIVE 2020-10-16 00:00:00 STATUS: ACTIVE 2020-10-16 00:00:00 STATUS: ACTIVE