| NAME |
LEUPROLIDE ACETATE 22.5MG (3 MONTH) INJ,SUSP,SA |
| VA GENERIC NAME |
LEUPROLIDE |
| DOSAGE FORM |
INJ,SUSP,SA |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
22.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
LEUPROLIDE INJ,SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-11-25 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LEUPROLIDE 22.5MG (3 MONTH) SA INJ |
| VA PRODUCT IDENTIFIER |
L0908 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041851 |
| EFFECTIVE DATE/TIME |
-
- 2022-11-25 00:00:00
- STATUS: ACTIVE
|
