| NAME |
TICARCILLIN 3GM/CLAVULANATE K 0.1GM/VIL INJ |
| VA GENERIC NAME |
CLAVULANATE/TICARCILLIN |
| DOSAGE FORM |
INJ |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
3.1 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
GM/VIAL |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
CLAVULANATE/TICARCILLIN INJ |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 |
4004697 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
