| NAME |
LANREOTIDE 120MG INJ,SUSP,SA SYRINGE |
| VA GENERIC NAME |
LANREOTIDE |
| DOSAGE FORM |
INJ,SUSP,SA |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
120 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
LANREOTIDE INJ,SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2022-02-02 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-02-03 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LANREOTIDE 120MG SA SUSP INJ SYRINGE |
| VA PRODUCT IDENTIFIER |
L0414 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4026597 |
| EFFECTIVE DATE/TIME |
-
- 2007-10-10 00:00:00
- STATUS: ACTIVE
|
