A safety vial system for enclosing a drug vial filled with a hazardous drug comprising: a vial adapter subsystem comprising a main body assembly, an activation housing assembly irreversibly coupled and hermetically sealed to the main body assembly and yet movable telescopically and axially in a distal direction with respect to the main body assembly between a first proximally raised position and a second distally extended lowered position, and a product integrity ring releasably coupling the vial adapter subsystem with the main body assembly to retain the activation housing assembly in the first proximally raised position until forcibly released; a vial base subsystem including a bellows base assembly comprising a bellows base and an expandable bellows comprising a flexible bellows film having an upper surface and a lower surface and being sealingly attached to the bellows base to define an expandable bellows chamber between the upper surface of the bellows film and the bellows base; and a vial having a central longitudinal axis, a bottom wall, a side wall joined with the bottom wall and extending around the central longitudinal axis to form an upper portion that has a top opening sealed with a stopper to define a internal reservoir for containing a medicament, the vial having an external surface and being disposed between the vial adapter subsystem and the vial base subsystem with the bottom wall directed toward the vial base subsystem; wherein the vial adapter subsystem and the vial base subsystem are generally tubular and arranged along a common central longitudinal axis with the central longitudinal axis of the vial and the vial is supported by at least one of the vial adapter subsystem and the vial base subsystem; wherein the vial adapter subsystem and the vial base subsystem are movably telescopically connected to each other in a first position wherein an open pathway is provided for a sterilization gas to sterilize the external surface of the vial while the vial is supported between the vial adapter subsystem and the vial base subsystem; and wherein the vial base subsystem and the vial adapter subsystem are telescopically movable toward each other and into a second position wherein the pathway is hermetically sealed closed after the external surface of the vial is sterilized with the sterilization gas. a vial adapter subsystem comprising a main body assembly, an activation housing assembly irreversibly coupled and hermetically sealed to the main body assembly and yet movable telescopically and axially in a distal direction with respect to the main body assembly between a first proximally raised position and a second distally extended lowered position, and a product integrity ring releasably coupling the vial adapter subsystem with the main body assembly to retain the activation housing assembly in the first proximally raised position until forcibly released; a vial base subsystem including a bellows base assembly comprising a bellows base and an expandable bellows comprising a flexible bellows film having an upper surface and a lower surface and being sealingly attached to the bellows base to define an expandable bellows chamber between the upper surface of the bellows film and the bellows base; and a vial having a central longitudinal axis, a bottom wall, a side wall joined with the bottom wall and extending around the central longitudinal axis to form an upper portion that has a top opening sealed with a stopper to define a internal reservoir for containing a medicament, the vial having an external surface and being disposed between the vial adapter subsystem and the vial base subsystem with the bottom wall directed toward the vial base subsystem; wherein the vial adapter subsystem and the vial base subsystem are generally tubular and arranged along a common central longitudinal axis with the central longitudinal axis of the vial and the vial is supported by at least one of the vial adapter subsystem and the vial base subsystem; wherein the vial adapter subsystem and the vial base subsystem are movably telescopically connected to each other in a first position wherein an open pathway is provided for a sterilization gas to sterilize the external surface of the vial while the vial is supported between the vial adapter subsystem and the vial base subsystem; and wherein the vial base subsystem and the vial adapter subsystem are telescopically movable toward each other and into a second position wherein the pathway is hermetically sealed closed after the external surface of the vial is sterilized with the sterilization gas.