LIOTRIX-3 150MCG/37.5MCG TAB (23105) VA PRODUCT (50.68)

Name	Value
NAME	LIOTRIX-3 150MCG/37.5MCG TAB
VA GENERIC NAME	LEVOTHYROXINE/LIOTHYRONINE
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	LEVOTHYROXINE SODIUM STRENGTH: 150 UNITS: MCG LIOTHYRONINE SODIUM STRENGTH: 37.5 UNITS: MCG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2022-01-15 00:00:00
NATIONAL FORMULARY NAME	LEVOTHYROXINE/LIOTHYRONINE TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2021-10-20 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2021-10-21 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	LIOTRIX-3 150MCG/37.5MCG TAB
VA PRODUCT IDENTIFIER	L0549
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4031497
EFFECTIVE DATE/TIME	2012-06-11 00:00:00 STATUS: ACTIVE 2022-01-15 00:00:00 STATUS: INACTIVE