| NAME |
ALIROCUMAB 75MG/ML INJ,PEN,1ML |
| VA GENERIC NAME |
ALIROCUMAB |
| DOSAGE FORM |
INJ,SOLN |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
75 |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
ALIROCUMAB INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
ALIROCUMAB 75MG/ML INJ 1ML PEN |
| VA PRODUCT IDENTIFIER |
A1823 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034690 |
| EFFECTIVE DATE/TIME |
-
- 2015-08-11 00:00:00
- STATUS: ACTIVE
|
