| NAME |
GANCICLOVIR 250MG CAP |
| VA GENERIC NAME |
GANCICLOVIR |
| DOSAGE FORM |
CAP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| NATIONAL FORMULARY RESTRICTION |
Refer to HIV/AIDS TAG treatment guidelines
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
250 |
| INACTIVATION DATE |
2012-09-06 00:00:00 |
| UNITS |
MG |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
GANCICLOVIR CAP,ORAL |
| 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 |
GANCICLOVIR 250MG CAP |
| VA PRODUCT IDENTIFIER |
G0128 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008897 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2012-09-06 00:00:00
- STATUS: INACTIVE
|
