| NAME |
SIROLIMUS PROTIEN-BOUND 100MG/VIAL INJ,LYPHL |
| VA GENERIC NAME |
SIROLIMUS |
| DOSAGE FORM |
INJ,LYPHL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
100 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| INACTIVATION DATE |
2023-05-15 00:00:00 |
| UNITS |
MG/VIAL |
| NATIONAL FORMULARY NAME |
SIROLIMUS INJ,LYPHL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-12-09 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SIROLIMUS PROTIEN-BOUND 100MG/VI INJ |
| VA PRODUCT IDENTIFIER |
S0943 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041021 |
| EFFECTIVE DATE/TIME |
-
- 2021-12-09 00:00:00
- STATUS: ACTIVE
-
- 2023-05-15 00:00:00
- STATUS: INACTIVE
|
