| NAME |
MITOMYCIN 0.5MG/ML INJ |
| VA GENERIC NAME |
MITOMYCIN |
| DOSAGE FORM |
INJ |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restrict to Hematology/Oncology
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.5 |
| INACTIVATION DATE |
2009-06-12 00:00:00 |
| UNITS |
MG/ML |
| DSS NUMBER |
3 |
| NATIONAL FORMULARY NAME |
MITOMYCIN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| TRANSMIT TO CMOP |
NO |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003769 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2009-06-12 00:00:00
- STATUS: INACTIVE
|
