TRIAMCINOLONE ACETONIDE (EQV-XIPERE) 40MG/ML INJ,SUSP,OPH (32491)    VA PRODUCT (50.68)

Name Value
NAME TRIAMCINOLONE ACETONIDE (EQV-XIPERE) 40MG/ML INJ,SUSP,OPH
VA GENERIC NAME TRIAMCINOLONE
DOSAGE FORM INJ,SUSP
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT
RESTRICTION TO OPHTHALMOLOGY
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 40
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG/ML
NATIONAL FORMULARY NAME TRIAMCINOLONE INJ,SUSP
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2023-02-06 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME TRIAMCINOLONE (EQV-XIPERE) 40MG/ML OPH
VA PRODUCT IDENTIFIER T1139
TRANSMIT TO CMOP NO
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4042007
EFFECTIVE DATE/TIME
  • 2023-02-06 00:00:00
    STATUS:   ACTIVE