| NAME |
EVOLOCUMAB 120MG/ML INJ,PUSHTRONEX,KIT,3.5ML |
| VA GENERIC NAME |
EVOLOCUMAB |
| DOSAGE FORM |
INJ,SOLN |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
120 |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
EVOLOCUMAB 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 |
EVOLOCUMAB 120MG/ML PUSHTRONEX 3.5ML KIT |
| VA PRODUCT IDENTIFIER |
E0687 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035932 |
| EFFECTIVE DATE/TIME |
-
- 2016-07-27 00:00:00
- STATUS: ACTIVE
|
