| NAME |
LEVOTHYROXINE NA 125MCG TAB (SYNTHROID) |
| VA GENERIC NAME |
LEVOTHYROXINE |
| DOSAGE FORM |
TAB |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
125 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MCG |
| NATIONAL FORMULARY NAME |
LEVOTHYROXINE TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 1
- COPAY EFFECTIVE DATE: 2019-10-22 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LEVOTHYROXINE NA (SYNTHROID) 125MCG TAB |
| VA PRODUCT IDENTIFIER |
L0820 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038806 |
| EFFECTIVE DATE/TIME |
-
- 2019-10-22 00:00:00
- STATUS: ACTIVE
|
