| NAME |
BENRALIZUMAB 30MG/ML INJ,SYR,1ML |
| VA GENERIC NAME |
BENRALIZUMAB |
| DOSAGE FORM |
INJ,SOLN |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
30 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
BENRALIZUMAB INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-01-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BENRALIZUMAB 30MG/ML INJ SYR 1ML |
| VA PRODUCT IDENTIFIER |
B0849 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037104 |
| EFFECTIVE DATE/TIME |
-
- 2017-11-24 00:00:00
- STATUS: ACTIVE
|
