MARLISSA TAB,28 (24401) VA PRODUCT (50.68)

Name	Value
NAME	MARLISSA TAB,28
VA GENERIC NAME	ETHINYL ESTRADIOL/LEVONORGESTREL
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	ETHINYL ESTRADIOL STRENGTH: 0.03 UNITS: MG LEVONORGESTREL STRENGTH: 0.15 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	ETHINYL ESTRADIOL/LEVONORGESTREL 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
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	MARLISSA TAB,28
VA PRODUCT IDENTIFIER	M1014
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	CYCLE
MASTER ENTRY FOR VUID	YES
VUID	4032973
EFFECTIVE DATE/TIME	2014-01-17 00:00:00 STATUS: ACTIVE