BREXUCABTAGENE AUTOLEUCEL INFUSION BAG (30321)    VA PRODUCT (50.68)

Name Value
NAME BREXUCABTAGENE AUTOLEUCEL INFUSION BAG
VA GENERIC NAME BREXUCABTAGENE AUTOLEUCEL
DOSAGE FORM INJ,SUSP
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
NATIONAL FORMULARY NAME BREXUCABTAGENE AUTOLEUCEL INJ,SUSP
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:   2020-08-07 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BREXUCABTAGENE AUTOLEUCEL INFUSION BAG
VA PRODUCT IDENTIFIER B0905
TRANSMIT TO CMOP NO
VA DISPENSE UNIT BAG
MASTER ENTRY FOR VUID YES
VUID 4039595
EFFECTIVE DATE/TIME
  • 2020-08-07 00:00:00
    STATUS:   ACTIVE
  • 2020-08-07 00:00:00
    STATUS:   ACTIVE