| NAME |
HISTRELIN ACETATE 50MG IMPLANT |
| VA GENERIC NAME |
HISTRELIN |
| DOSAGE FORM |
IMPLANT |
| FDA MED GUIDE |
Histrelin_(Supprelin_LA)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
50 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
HISTRELIN IMPLANT |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
HISTRELIN ACETATE 50MG IMPLANT |
| VA PRODUCT IDENTIFIER |
H0492 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4025319 |
| EFFECTIVE DATE/TIME |
-
- 2006-07-20 00:00:00
- STATUS: ACTIVE
|
