| NAME |
RELUGOLIX 120MG TAB |
| VA GENERIC NAME |
RELUGOLIX |
| DOSAGE FORM |
TAB |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Relugolix is a GnRH antagonist FDA-approved for the treatment of advanced prostate cancer
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
120 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
RELUGOLIX TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2021-01-07 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
RELUGOLIX 120MG TAB |
| VA PRODUCT IDENTIFIER |
R0413 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4039942 |
| EFFECTIVE DATE/TIME |
-
- 2021-01-07 00:00:00
- STATUS: ACTIVE
-
- 2021-01-07 00:00:00
- STATUS: ACTIVE
-
- 2021-01-07 00:00:00
- STATUS: ACTIVE
|
