| NAME |
POLATUZUMAB VEDOTIN-PIIQ 140MG/VIAL INJ,LYPHL |
| VA GENERIC NAME |
POLATUZUMAB VEDOTIN-PIIQ |
| DOSAGE FORM |
INJ,LYPHL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
140 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/VIAL |
| NATIONAL FORMULARY NAME |
POLATUZUMAB VEDOTIN-PIIQ INJ,LYPHL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2019-06-21 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
POLATUZUMAB VEDOTIN-PIIQ 140MG/VIAL INJ |
| VA PRODUCT IDENTIFIER |
P1243 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038486 |
| EFFECTIVE DATE/TIME |
-
- 2019-06-21 00:00:00
- STATUS: ACTIVE
-
- 2019-06-21 00:00:00
- STATUS: ACTIVE
|
