| NAME |
BICTEGRAVIR 30MG/EMTRICITABINE 120MG/TENOFOVIR AF 15MG TAB |
| VA GENERIC NAME |
BICTEGRAVIR/EMTRICITABINE/TENOFOVIR |
| DOSAGE FORM |
TAB,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
BICTEGRAVIR/EMTRICITABINE/TENOFOVIR TAB,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2021-12-09 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BIKTARVY 30/120/15MG TAB |
| VA PRODUCT IDENTIFIER |
B0926 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041023 |
| EFFECTIVE DATE/TIME |
-
- 2021-12-09 00:00:00
- STATUS: ACTIVE
|
