| NAME |
EDARAVONE 105MG/5MG SUSP,ORAL STARTER KIT |
| VA GENERIC NAME |
EDARAVONE |
| DOSAGE FORM |
SUSP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-N |
| FORMULARY DESIGNATOR TEXT |
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
105 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2022-06-08 00:00:00 |
| UNITS |
MG/5MG |
| NATIONAL FORMULARY NAME |
EDARAVONE SUSP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| 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 |
EDARAVONE 105MG/5MG ORAL SUSP START KIT |
| VA PRODUCT IDENTIFIER |
E0856 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041440 |
| EFFECTIVE DATE/TIME |
-
- 2022-05-26 00:00:00
- STATUS: ACTIVE
-
- 2022-06-08 00:00:00
- STATUS: INACTIVE
|
