| NAME |
LEUPROLIDE ACETATE (FENSOLVI) 45MG (PED 6 MONTH) INJ,SUSP,SA |
| VA GENERIC NAME |
LEUPROLIDE |
| DOSAGE FORM |
INJ,SUSP,SA |
| FDA MED GUIDE |
Leuprolide_(Fensolvi)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| WASTE SORT CODE |
CHEMO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
45 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
LEUPROLIDE INJ,SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2023-04-20 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LEUPROLIDE (FENSOLVI) 45MG(PED 6M)SA INJ |
| VA PRODUCT IDENTIFIER |
L0922 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4042180 |
| EFFECTIVE DATE/TIME |
-
- 2023-04-20 00:00:00
- STATUS: ACTIVE
|
