| NAME |
LEUPROLIDE 11.25MG INJ (3 MONTH)/NORETHINDRONE 5MG TAB X 90,KIT |
| VA GENERIC NAME |
LEUPROLIDE/NORETHINDRONE |
| DOSAGE FORM |
KIT |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2022-03-15 00:00:00 |
| NATIONAL FORMULARY NAME |
LEUPROLIDE/NORETHINDRONE KIT |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2021-12-15 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-12-16 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LUPANETA 11.25-5MG 3-MONTH KIT |
| VA PRODUCT IDENTIFIER |
L0618 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033044 |
| EFFECTIVE DATE/TIME |
-
- 2014-01-30 00:00:00
- STATUS: ACTIVE
-
- 2022-03-15 00:00:00
- STATUS: INACTIVE
|
