| NAME |
LARISSIA TAB,28 |
| VA GENERIC NAME |
ETHINYL ESTRADIOL/LEVONORGESTREL |
| DOSAGE FORM |
TAB |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| INACTIVATION DATE |
2022-12-15 00:00:00 |
| NATIONAL FORMULARY NAME |
ETHINYL ESTRADIOL/LEVONORGESTREL TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LARISSIA TAB 28 |
| VA PRODUCT IDENTIFIER |
L0709 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CYCLE |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035995 |
| EFFECTIVE DATE/TIME |
-
- 2016-08-19 00:00:00
- STATUS: ACTIVE
-
- 2022-12-15 00:00:00
- STATUS: INACTIVE
|
