| NAME |
ELAGOLIX 200MG TAB |
| VA GENERIC NAME |
ELAGOLIX |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Elagolix_(Orilissa)_(2021).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
200 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
ELAGOLIX TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-08-02 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ELAGOLIX 200MG TAB |
| VA PRODUCT IDENTIFIER |
E0758 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037726 |
| EFFECTIVE DATE/TIME |
-
- 2018-08-02 00:00:00
- STATUS: ACTIVE
|
