BLEOMYCIN SO4 15UNT/AMP INJ (3202)    VA PRODUCT (50.68)

Name Value
NAME BLEOMYCIN SO4 15UNT/AMP INJ
VA GENERIC NAME BLEOMYCIN
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 15
INACTIVATION DATE 2008-09-02 00:00:00
UNITS UNIT/AMP
DSS NUMBER 2
NATIONAL FORMULARY NAME BLEOMYCIN INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BLEOMYCIN SO4 15UNT/AMP INJ
VA PRODUCT IDENTIFIER B0292
TRANSMIT TO CMOP NO
VA DISPENSE UNIT AMP
MASTER ENTRY FOR VUID YES
VUID 4003772
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-28 00:00:00
    STATUS:   INACTIVE
  • 2007-10-10 00:00:00
    STATUS:   ACTIVE
  • 2008-09-02 00:00:00
    STATUS:   INACTIVE