ELEXACAFTOR/TEZACAFTOR/IVACAFTOR 50-25-37.5MG/75MG TAB,21 (31228) VA PRODUCT (50.68)

Name	Value
NAME	ELEXACAFTOR/TEZACAFTOR/IVACAFTOR 50-25-37.5MG/75MG TAB,21
VA GENERIC NAME	ELEXACAFTOR/IVACAFTOR/TEZACAFTOR
DOSAGE FORM	TAB
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	IVACAFTOR STRENGTH: 37.5-75 UNITS: MG TEZACAFTOR STRENGTH: 25 UNITS: MG ELEXACAFTOR STRENGTH: 50 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	ELEXACAFTOR/IVACAFTOR/TEZACAFTOR TAB
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: 2021-06-24 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	TRIKAFTA 50-25-37.5MG/75MG TAB,21
VA PRODUCT IDENTIFIER	T1090
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	PKG
MASTER ENTRY FOR VUID	YES
VUID	4040595
EFFECTIVE DATE/TIME	2021-06-24 00:00:00 STATUS: ACTIVE 2021-06-24 00:00:00 STATUS: ACTIVE 2021-06-24 00:00:00 STATUS: ACTIVE 2021-06-24 00:00:00 STATUS: ACTIVE