DOLISHALE TAB,28 (31055) VA PRODUCT (50.68)

Name	Value
NAME	DOLISHALE TAB,28
VA GENERIC NAME	ETHINYL ESTRADIOL/LEVONORGESTREL
DOSAGE FORM	TAB
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	ETHINYL ESTRADIOL STRENGTH: 20 UNITS: MCG LEVONORGESTREL STRENGTH: 90 UNITS: MCG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	ETHINYL ESTRADIOL/LEVONORGESTREL TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2021-04-29 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	DOLISHALE TAB,28
VA PRODUCT IDENTIFIER	D1260
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CYCLE
MASTER ENTRY FOR VUID	YES
VUID	4040399
EFFECTIVE DATE/TIME	2021-04-29 00:00:00 STATUS: ACTIVE 2021-04-29 00:00:00 STATUS: ACTIVE 2021-04-29 00:00:00 STATUS: ACTIVE