PERTUZUMAB 1,200MG/TRASTUZUMAB 600MG/HYAL-ZZXF INJ,VIL,15ML (30246) VA PRODUCT (50.68)

Name	Value
NAME	PERTUZUMAB 1,200MG/TRASTUZUMAB 600MG/HYAL-ZZXF INJ,VIL,15ML
VA GENERIC NAME	PERTUZUMAB/TRASTUZUMAB/HYALURONIDASE-ZZXF
DOSAGE FORM	INJ,SOLN
HAZARDOUS TO DISPOSE	NO
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to hematology/oncology
ACTIVE INGREDIENTS	TRASTUZUMAB STRENGTH: 600 UNITS: MG/15ML PERTUZUMAB STRENGTH: 1200 UNITS: MG/15ML HYALURONIDASE-ZZXF STRENGTH: 30000 UNITS: UNIT/15ML
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	PERTUZUMAB/TRASTUZUMAB/HYALURONIDASE-ZZXF INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	No Possible Dosages
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2020-07-09 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	PHESGO 1,200MG/600MG INJ VIL 15ML
VA PRODUCT IDENTIFIER	P1277
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	VI
MASTER ENTRY FOR VUID	YES
VUID	4039514
EFFECTIVE DATE/TIME	2020-07-09 00:00:00 STATUS: ACTIVE