DIETHYLSTILBESTROL 0.25MG/METHYLTESTOSTERONE 5MG TAB (178) VA PRODUCT (50.68)

Name	Value
NAME	DIETHYLSTILBESTROL 0.25MG/METHYLTESTOSTERONE 5MG TAB
VA GENERIC NAME	DIETHYLSTILBESTROL/METHYLTESTOSTERONE
DOSAGE FORM	TAB
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	DIETHYLSTILBESTROL STRENGTH: 0.25 UNITS: MG METHYLTESTOSTERONE STRENGTH: 5 UNITS: MG
CS FEDERAL SCHEDULE	Schedule IV
INACTIVATION DATE	2002-05-24 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	DIETHYLSTILBESTROL/METHYLTESTOSTERONE TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4000801
EFFECTIVE DATE/TIME	2002-05-24 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE