| NAME |
TISAGENLECLEUCEL INJ,SUSP |
| VA GENERIC NAME |
TISAGENLECLEUCEL |
| DOSAGE FORM |
INJ,SUSP |
| FDA MED GUIDE |
Tisagenlecleucel_(Kymriah)_(2017).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
TISAGENLECLEUCEL INJ,SUSP |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-11-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TISAGENLECLEUCEL SUSP INJ |
| VA PRODUCT IDENTIFIER |
T0966 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
BAG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036936 |
| EFFECTIVE DATE/TIME |
-
- 2017-10-12 00:00:00
- STATUS: ACTIVE
|
