BALCOLTRA TAB,28 (28474) VA PRODUCT (50.68)

Name	Value
NAME	BALCOLTRA TAB,28
VA GENERIC NAME	ETHINYL ESTRADIOL/FERROUS BISGLYCINATE/LEVONORGESTREL
DOSAGE FORM	TAB
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	FERROUS BISGLYCINATE STRENGTH: 36.5 UNITS: MG ETHINYL ESTRADIOL STRENGTH: 0.02 UNITS: MG LEVONORGESTREL STRENGTH: 0.1 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	ETHINYL ESTRADIOL/FERROUS BISGLYCINATE/LEVONORGESTREL TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2018-06-01 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	BALCOLTRA TAB,28
VA PRODUCT IDENTIFIER	B0860
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CYCLE
MASTER ENTRY FOR VUID	YES
VUID	4037489
EFFECTIVE DATE/TIME	2018-04-30 00:00:00 STATUS: ACTIVE