| NAME |
GANCICLOVIR 4.5MG IMPLANT,OPH |
| VA GENERIC NAME |
GANCICLOVIR |
| DOSAGE FORM |
IMPLANT |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY RESTRICTION |
Refer to HIV/AIDS TAG treatment guidelines
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
4.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2016-06-15 00:00:00 |
| UNITS |
MG |
| DSS NUMBER |
3 |
| NATIONAL FORMULARY NAME |
GANCICLOVIR IMPLANT |
| 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 4.5MG OPH IMPLANT |
| VA PRODUCT IDENTIFIER |
G0144 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008898 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
