BACLOFEN 0.05MG/ML (PF) INJ,INTRATHECAL,SYRINGE,1ML (30977)    VA PRODUCT (50.68)

Name Value
NAME BACLOFEN 0.05MG/ML (PF) INJ,INTRATHECAL,SYRINGE,1ML
VA GENERIC NAME BACLOFEN
DOSAGE FORM INJ
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 0.05
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG/ML
NATIONAL FORMULARY NAME BACLOFEN INJ
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:   2021-04-05 00:00:00
    COPAY END DATE:   2021-09-02 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-09-03 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BACLOFEN 0.05MG/ML PF INTRATHEC SYR 1ML
VA PRODUCT IDENTIFIER B0914
TRANSMIT TO CMOP NO
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4040315
EFFECTIVE DATE/TIME
  • 2021-04-05 00:00:00
    STATUS:   ACTIVE
  • 2021-04-05 00:00:00
    STATUS:   ACTIVE
  • 2021-04-05 00:00:00
    STATUS:   ACTIVE