| NAME |
LEVOTHYROXINE NA 175MCG CAP |
| VA GENERIC NAME |
LEVOTHYROXINE |
| DOSAGE FORM |
CAP,ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
175 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MCG |
| NATIONAL FORMULARY NAME |
LEVOTHYROXINE CAP,ORAL |
| 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: 2019-10-22 00:00:00
- COPAY END DATE: 2020-11-26 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-11-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LEVOTHYROXINE NA 175MCG CAP |
| VA PRODUCT IDENTIFIER |
L0836 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038822 |
| EFFECTIVE DATE/TIME |
-
- 2019-10-22 00:00:00
- STATUS: ACTIVE
|
