| NAME |
INV-NIRMATRELVIR 150MG X 4/RITONAVIR 100MG X 2 TAB DAILY PACK,6 |
| VA GENERIC NAME |
NIRMATRELVIR/RITONAVIR |
| DOSAGE FORM |
TAB,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2022-01-07 00:00:00 |
| NATIONAL FORMULARY NAME |
NIRMATRELVIR/RITONAVIR TAB,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2021-12-30 00:00:00
- COPAY END DATE: 2022-01-05 00:00:00
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2022-01-06 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
INV-PAXLOVID 150MGX4/100MGX2 DAILY PKT,6 |
| VA PRODUCT IDENTIFIER |
I0725 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041070 |
| EFFECTIVE DATE/TIME |
-
- 2021-12-30 00:00:00
- STATUS: ACTIVE
-
- 2022-01-07 00:00:00
- STATUS: INACTIVE
|
