LEUPROLIDE ACETATE 22.5MG/KIT INJ,SUSP,SA (6835)    VA PRODUCT (50.68)

Name Value
NAME LEUPROLIDE ACETATE 22.5MG/KIT INJ,SUSP,SA
VA GENERIC NAME LEUPROLIDE
DOSAGE FORM INJ,SUSP,SA
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 11.25
INACTIVATION DATE 2002-10-30 00:00:00
UNITS MG
DSS NUMBER 7
NATIONAL FORMULARY NAME LEUPROLIDE INJ,SUSP,SA
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME LEUPROLIDE ACETATE 22.5MG/KIT SA SUSP IJ
VA PRODUCT IDENTIFIER L0172
TRANSMIT TO CMOP YES
VA DISPENSE UNIT KIT
MASTER ENTRY FOR VUID NO
VUID 4007350
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2005-12-08 00:00:00
    STATUS:   ACTIVE
  • 2008-12-15 00:00:00
    STATUS:   INACTIVE
  • 2002-10-30 00:00:00
    STATUS:   INACTIVE
  • 2008-12-15 00:00:00
    STATUS:   INACTIVE