| NAME |
EFALIZUMAB 125MG/VIL INJ |
| VA GENERIC NAME |
EFALIZUMAB |
| DOSAGE FORM |
INJ,LYPHL |
| FDA MED GUIDE |
Efalizumab_(Raptiva)_(2009).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
125 |
| INACTIVATION DATE |
2011-07-08 00:00:00 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
EFALIZUMAB INJ,LYPHL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
EFALIZUMAB 125MG/VIL INJ |
| VA PRODUCT IDENTIFIER |
E0376 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4016846 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2011-07-08 00:00:00
- STATUS: INACTIVE
|
