| NAME |
BACLOFEN 40MG/20ML X 2 AMP KIT,INTRATHECAL |
| VA GENERIC NAME |
BACLOFEN |
| DOSAGE FORM |
INJ |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
40 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/20ML |
| NATIONAL FORMULARY NAME |
BACLOFEN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2023-03-23 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BACLOFEN 40MG/20ML 2 AMP KIT INTRATHECAL |
| VA PRODUCT IDENTIFIER |
B0960 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4042125 |
| EFFECTIVE DATE/TIME |
-
- 2023-03-23 00:00:00
- STATUS: ACTIVE
|
