REBETRON 1200/PAK 3 PKT (1241-01) (12869) VA PRODUCT (50.68)

Name	Value
NAME	REBETRON 1200/PAK 3 PKT (1241-01)
VA GENERIC NAME	INTERFERON ALFA-2B/RIBAVIRIN
DOSAGE FORM	CAP/INJ
HAZARDOUS TO DISPOSE	NO
DOT SHIPPING CODE
FORMULARY DESIGNATOR	R
ACTIVE INGREDIENTS	INTERFERON ALFA-2B,RECOMBINANT STRENGTH: 6X3MIL U RIBAVIRIN STRENGTH: 84 X 200 UNITS: MG
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2008-03-26 00:00:00
DSS NUMBER	4
NATIONAL FORMULARY NAME	INTERFERON ALFA-2B/RIBAVIRIN CAP/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	REBETRON 1200/PAK 3 PKT (1241-01)
VA PRODUCT IDENTIFIER	R0084
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKT
MASTER ENTRY FOR VUID	YES
VUID	4013234
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-25 00:00:00 STATUS: INACTIVE 2007-10-10 00:00:00 STATUS: ACTIVE 2008-03-26 00:00:00 STATUS: INACTIVE