CERTOLIZUMAB PEGOL 200MG/ML INJ,SOLN SYR,2ML (20733)    VA PRODUCT (50.68)

Name Value
NAME CERTOLIZUMAB PEGOL 200MG/ML INJ,SOLN SYR,2ML
VA GENERIC NAME CERTOLIZUMAB
DOSAGE FORM INJ,SOLN
FDA MED GUIDE Certolizumab_(Cimzia)_(2019).pdf
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to providers appropriate for prescribing TNF inhibitors
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 200
INACTIVATION DATE 2009-09-16 00:00:00
UNITS MG/ML
NATIONAL FORMULARY NAME CERTOLIZUMAB INJ,SOLN
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 CERTOLIZUMAB PEGOL 200MG/ML INJ SYR 2ML
VA PRODUCT IDENTIFIER C1379
TRANSMIT TO CMOP YES
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4028772
EFFECTIVE DATE/TIME
  • 2009-07-09 00:00:00
    STATUS:   ACTIVE
  • 2009-09-16 00:00:00
    STATUS:   INACTIVE