| NAME |
PEGINTERFERON ALPHA-2A 180MCG/VI X4/RIBAVIRIN 200MG 168 KIT |
| VA GENERIC NAME |
PEGINTERFERON/RIBAVIRIN |
| DOSAGE FORM |
INJ/TAB |
| HAZARDOUS TO DISPOSE |
NO |
| DOT SHIPPING CODE |
|
| FORMULARY DESIGNATOR |
R |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2004-03-23 00:00:00 |
| NATIONAL FORMULARY NAME |
PEGINTERFERON/RIBAVIRIN KIT |
| 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 |
PEGASYS RBV CONV PACK 180X4/168 KIT |
| VA PRODUCT IDENTIFIER |
P0648 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4016332 |
| EFFECTIVE DATE/TIME |
-
- 2004-03-23 00:00:00
- STATUS: INACTIVE
-
- 2005-12-08 00:00:00
- STATUS: INACTIVE
|
