INFIGRATINIB 25MG X 21/100MG X 21 (125MG) DAILY PKT (31200)    VA PRODUCT (50.68)

Name Value
NAME INFIGRATINIB 25MG X 21/100MG X 21 (125MG) DAILY PKT
VA GENERIC NAME INFIGRATINIB
DOSAGE FORM CAP,ORAL
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
NATIONAL FORMULARY NAME INFIGRATINIB CAP,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:   2021-06-10 00:00:00
    COPAY END DATE:   2023-04-26 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2023-04-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME INFIGRATINIB 25-100MGX21(125MG)DAILY PKT
VA PRODUCT IDENTIFIER I0711
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKT
MASTER ENTRY FOR VUID YES
VUID 4040564
EFFECTIVE DATE/TIME
  • 2021-06-10 00:00:00
    STATUS:   ACTIVE
  • 2021-06-10 00:00:00
    STATUS:   ACTIVE
  • 2021-06-10 00:00:00
    STATUS:   ACTIVE