| NAME |
TESTOSTERONE ENANTHATE 100MG/TESTOSTERONE PROPIONATE 25MG/ML INJ |
| VA GENERIC NAME |
TESTOSTERONE |
| DOSAGE FORM |
INJ,SOLN |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| CS FEDERAL SCHEDULE |
Schedule III Non-Narcotics |
| INACTIVATION DATE |
2007-09-25 00:00:00 |
| DSS NUMBER |
14 |
| NATIONAL FORMULARY NAME |
TESTOSTERONE INJ,SOLN |
| 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 |
| VA PRINT NAME |
TESTOST E 100MG/TESTOST PROP 25MG/ML INJ |
| VA PRODUCT IDENTIFIER |
T0531 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4001137 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2007-09-25 00:00:00
- STATUS: INACTIVE
|
