| NAME |
SODIUM PHENYLBUTYRATE 3GM/TAURURSODIOL 1GM/PKT PWDR,ORAL |
| VA GENERIC NAME |
SODIUM PHENYLBUTYRATE/TAURURSODIOL |
| DOSAGE FORM |
PWDR,RENST-ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-N |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
SODIUM PHENYLBUTYRATE/TAURURSODIOL PWDR,RENST-ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-10-13 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
RELYVRIO 3GM/1GM PKT ORAL POWDER |
| VA PRODUCT IDENTIFIER |
R0454 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041753 |
| EFFECTIVE DATE/TIME |
-
- 2022-10-13 00:00:00
- STATUS: ACTIVE
|
