| NAME |
ALPELISIB 125MGX28 (125MG) TAB,ORAL PKT |
| VA GENERIC NAME |
ALPELISIB |
| DOSAGE FORM |
TAB,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
125 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
ALPELISIB TAB,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-04-21 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ALPELISIB 125MGX28 (125MG) PKT |
| VA PRODUCT IDENTIFIER |
A2120 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041357 |
| EFFECTIVE DATE/TIME |
-
- 2022-04-21 00:00:00
- STATUS: ACTIVE
|
