PEGINTERFERON ALFA-2B 200MCG/VIL INJ,KIT (26208)    VA PRODUCT (50.68)

Name Value
NAME PEGINTERFERON ALFA-2B 200MCG/VIL INJ,KIT
VA GENERIC NAME PEGINTERFERON
DOSAGE FORM INJ,LYPHL
FDA MED GUIDE Peginterferon_Alfa-2b_(Sylatron)_(2018).pdf
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 200
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2021-04-15 00:00:00
UNITS MCG/VIL
NATIONAL FORMULARY NAME PEGINTERFERON INJ,LYPHL
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2021-02-03 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-02-04 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME PEGINTERFERON ALFA-2B 200MCG/VIL INJ KIT
VA PRODUCT IDENTIFIER P1153
TRANSMIT TO CMOP YES
VA DISPENSE UNIT KIT
MASTER ENTRY FOR VUID YES
VUID 4035001
EFFECTIVE DATE/TIME
  • 2015-10-30 00:00:00
    STATUS:   ACTIVE
  • 2021-04-15 00:00:00
    STATUS:   INACTIVE
  • 2021-04-15 00:00:00
    STATUS:   INACTIVE
  • 2021-04-15 00:00:00
    STATUS:   INACTIVE