| NAME |
SODIUM TETRADECYL SO4 3% INJ |
| VA GENERIC NAME |
SODIUM TETRADECYL SULFATE |
| DOSAGE FORM |
INJ,SOLN |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
3 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
SODIUM TETRADECYL SULFATE INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2019-12-26 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-12-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SODIUM TETRADECYL SO4 3% INJ |
| VA PRODUCT IDENTIFIER |
S0509 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4007673 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
