CABOTEGRAVIR 400MG/RILPIVIRINE 600MG INJ,SUSP,SA KIT (30691) VA PRODUCT (50.68)

Name	Value
NAME	CABOTEGRAVIR 400MG/RILPIVIRINE 600MG INJ,SUSP,SA KIT
VA GENERIC NAME	CABOTEGRAVIR/RILPIVIRINE
DOSAGE FORM	INJ,SUSP,SA
HAZARDOUS TO DISPOSE	NO
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT
ACTIVE INGREDIENTS	RILPIVIRINE STRENGTH: 600 UNITS: MG/2ML CABOTEGRAVIR STRENGTH: 400 UNITS: MG/2ML
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	CABOTEGRAVIR/RILPIVIRINE INJ,SUSP,SA
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2021-02-04 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	CABENUVA 400MG/600MG INJ KIT
VA PRODUCT IDENTIFIER	C1973
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	KIT
MASTER ENTRY FOR VUID	YES
VUID	4040017
EFFECTIVE DATE/TIME	2021-02-04 00:00:00 STATUS: ACTIVE 2021-02-04 00:00:00 STATUS: ACTIVE 2021-02-04 00:00:00 STATUS: ACTIVE