| NAME |
LOMUSTINE 40MG CAP |
| VA GENERIC NAME |
LOMUSTINE |
| DOSAGE FORM |
CAP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restrict to Hematology/Oncology
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| NATIONAL FORMULARY RESTRICTION |
Refer to PBM/MAP Hypertension treatment and CHF treatment guidelines and
PBM/TAG Diabetes treatment guidelines
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
40 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
LOMUSTINE CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LOMUSTINE 40MG CAP |
| VA PRODUCT IDENTIFIER |
L0057 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003801 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
