IFOSFAMIDE 3GM/VIL/MESNA 1GM/AMP PKG INJ (8509)    VA PRODUCT (50.68)

Name Value
NAME IFOSFAMIDE 3GM/VIL/MESNA 1GM/AMP PKG INJ
VA GENERIC NAME IFOSFAMIDE/MESNA
DOSAGE FORM INJ
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restrict to Hematology/Oncology
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2008-07-01 00:00:00
DSS NUMBER 4
NATIONAL FORMULARY NAME IFOSFAMIDE/MESNA INJ
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME IFOSFAMIDE 3GM/VIL/MESNA 1GM/AMP PKG INJ
VA PRODUCT IDENTIFIER I0218
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKG
MASTER ENTRY FOR VUID YES
VUID 4008970
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2008-07-01 00:00:00
    STATUS:   INACTIVE