TRI-VYLIBRA LO TAB,28 (29002) VA PRODUCT (50.68)

Name	Value
NAME	TRI-VYLIBRA LO TAB,28
VA GENERIC NAME	ETHINYL ESTRADIOL/NORGESTIMATE
DOSAGE FORM	TAB
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	NORGESTIMATE STRENGTH: 0.180-0.250 UNITS: MG ETHINYL ESTRADIOL STRENGTH: 0.025 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	ETHINYL ESTRADIOL/NORGESTIMATE TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2019-01-17 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	TRI-VYLIBRA LO TAB 28
VA PRODUCT IDENTIFIER	T1005
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CYCLE
MASTER ENTRY FOR VUID	YES
VUID	4038108
EFFECTIVE DATE/TIME	2019-01-17 00:00:00 STATUS: ACTIVE