| NAME |
TIRZEPATIDE 7.5MG/0.5ML INJ,SOLN PACK,4 |
| VA GENERIC NAME |
TIRZEPATIDE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Tirzepatide_(Mounjaro)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
7.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/0.5ML |
| NATIONAL FORMULARY NAME |
TIRZEPATIDE INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-05-26 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TIRZEPATIDE 7.5MG/0.5ML INJ,SOLN PACK,4 |
| VA PRODUCT IDENTIFIER |
T1111 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041428 |
| EFFECTIVE DATE/TIME |
-
- 2022-05-26 00:00:00
- STATUS: ACTIVE
|
