TERIPARATIDE (FORTEO) 250MCG/ML (620MCG) INJ,PEN,2.48ML (31074)    VA PRODUCT (50.68)

Name Value
NAME TERIPARATIDE (FORTEO) 250MCG/ML (620MCG) INJ,PEN,2.48ML
VA GENERIC NAME TERIPARATIDE
DOSAGE FORM INJ,SOLN
FDA MED GUIDE Teriparatide_(Forteo)_(2020).pdf
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 620
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2022-03-24 00:00:00
UNITS MCG/2.48ML
NATIONAL FORMULARY NAME TERIPARATIDE INJ,SOLN
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:   2021-04-30 00:00:00
    COPAY END DATE:   2021-05-19 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-05-20 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME FORTEO 250MCG/ML (620MCG) 2.48ML PEN
VA PRODUCT IDENTIFIER F0716
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4040417
EFFECTIVE DATE/TIME
  • 2021-04-30 00:00:00
    STATUS:   ACTIVE
  • 2021-04-30 00:00:00
    STATUS:   ACTIVE
  • 2021-04-30 00:00:00
    STATUS:   ACTIVE
  • 2022-03-24 00:00:00
    STATUS:   INACTIVE