MITOMYCIN 40MG/MANNITOL 80MG/VIL INJ (3200)    VA PRODUCT (50.68)

Name Value
NAME MITOMYCIN 40MG/MANNITOL 80MG/VIL 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 40
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2017-06-16 00:00:00
UNITS MG/VIAL
DSS NUMBER 4
NATIONAL FORMULARY NAME MITOMYCIN INJ
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
CODING SYSTEM
  • RxNorm
    CODE:
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 4003770
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2009-06-12 00:00:00
    STATUS:   INACTIVE
  • 2009-08-11 00:00:00
    STATUS:   ACTIVE