BEVACIZUMAB 25MG/ML INJ,OPH,SYRINGE,0.12ML (31339)    VA PRODUCT (50.68)

Name Value
NAME BEVACIZUMAB 25MG/ML INJ,OPH,SYRINGE,0.12ML
VA GENERIC NAME BEVACIZUMAB
DOSAGE FORM INJ,SOLN
HAZARDOUS TO DISPOSE NO
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restrict to Hematology/Oncology
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 25
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG/ML
NATIONAL FORMULARY NAME BEVACIZUMAB 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:   2021-07-30 00:00:00
    COPAY END DATE:   2021-08-18 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2021-08-19 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BEVACIZUMAB 25MG/ML OPH SYR 0.12ML
VA PRODUCT IDENTIFIER B0920
TRANSMIT TO CMOP NO
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4040713
EFFECTIVE DATE/TIME
  • 2021-08-02 00:00:00
    STATUS:   ACTIVE
  • 2021-08-02 00:00:00
    STATUS:   ACTIVE