| NAME |
SIPULEUCEL-T/LACTATED RINGERS INJ,SUSP,250ML |
| VA GENERIC NAME |
SIPULEUCEL-T |
| DOSAGE FORM |
INJ,SUSP |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
SIPULEUCEL-T INJ,SUSP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SIPULEUCEL-T/LR SUSP INJ 250ML |
| VA PRODUCT IDENTIFIER |
S0657 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
BAG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4030023 |
| EFFECTIVE DATE/TIME |
-
- 2010-08-13 00:00:00
- STATUS: ACTIVE
|
