| NAME |
BACLOFEN 5MG/ML SUSP,ORAL |
| VA GENERIC NAME |
BACLOFEN |
| DOSAGE FORM |
SUSP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
5 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
BACLOFEN SUSP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-02-17 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 |
BACLOFEN 5MG/ML ORAL SUSP |
| VA PRODUCT IDENTIFIER |
B0931 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041165 |
| EFFECTIVE DATE/TIME |
-
- 2022-02-17 00:00:00
- STATUS: ACTIVE
|
