ADALIMUMAB 80MG/0.8ML INJ,PEN,CROHNS STARTER PKG,3 (28516)    VA PRODUCT (50.68)

Name Value
NAME ADALIMUMAB 80MG/0.8ML INJ,PEN,CROHNS STARTER PKG,3
VA GENERIC NAME ADALIMUMAB
DOSAGE FORM INJ,SOLN
FDA MED GUIDE Adalimumab_(Humira)_(Oct_2018).pdf
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to providers appropriate for prescribing TNF inhibitors
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 80
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2020-12-23 00:00:00
UNITS MG/0.8ML
NATIONAL FORMULARY NAME ADALIMUMAB INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2018-06-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME ADALIMUMAB 80MG/PEN CROHNS STARTER PKG,3
VA PRODUCT IDENTIFIER A1972
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKG
MASTER ENTRY FOR VUID YES
VUID 4037536
EFFECTIVE DATE/TIME
  • 2018-05-11 00:00:00
    STATUS:   ACTIVE
  • 2020-12-23 00:00:00
    STATUS:   INACTIVE
  • 2020-12-23 00:00:00
    STATUS:   INACTIVE
  • 2020-12-23 00:00:00
    STATUS:   INACTIVE