LEUPROLIDE ACETATE (LUPRON-PED) 11.25MG (3 MONTH) INJ,SUSP,SA (29355)    VA PRODUCT (50.68)

Name Value
NAME LEUPROLIDE ACETATE (LUPRON-PED) 11.25MG (3 MONTH) INJ,SUSP,SA
VA GENERIC NAME LEUPROLIDE
DOSAGE FORM INJ,SUSP,SA
FDA MED GUIDE Leuprolide_(Lupron_Depot-Ped)_(2023).pdf
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 11.25
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG
NATIONAL FORMULARY NAME LEUPROLIDE INJ,SUSP,SA
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2019-06-28 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME LUPRON-PED 11.25MG (3 MONTH) SA INJ
VA PRODUCT IDENTIFIER L0797
TRANSMIT TO CMOP NO
VA DISPENSE UNIT KIT
MASTER ENTRY FOR VUID YES
VUID 4038510
EFFECTIVE DATE/TIME
  • 2019-07-01 00:00:00
    STATUS:   ACTIVE
  • 2019-07-01 00:00:00
    STATUS:   ACTIVE