| NAME |
ETHINYL ESTRADIOL 30MCG/LEVONORGESTREL 120MCG/24HR PATCH |
| VA GENERIC NAME |
ETHINYL ESTRADIOL/LEVONORGESTREL |
| DOSAGE FORM |
PATCH |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
ETHINYL ESTRADIOL/LEVONORGESTREL PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2020-07-09 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ESTRADIOL 30/LEVONORGE 120MCG/24HR PATCH |
| VA PRODUCT IDENTIFIER |
E0813 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4039512 |
| EFFECTIVE DATE/TIME |
-
- 2020-07-09 00:00:00
- STATUS: ACTIVE
|
