FOLLICLE STIMULATING 150UNT/LUTEINIZING HORMONE 150UNT/AMP INJ (7574) VA PRODUCT (50.68)

Name	Value
NAME	FOLLICLE STIMULATING 150UNT/LUTEINIZING HORMONE 150UNT/AMP INJ
VA GENERIC NAME	FOLLICLE STIMULATING HORMONE/LUTEINIZING HORMONE
DOSAGE FORM	INJ,SOLN
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to non-VA infertility referral/VA infertility Specialist
ACTIVE INGREDIENTS	LUTEINIZING HORMONE STRENGTH: 150 UNITS: UNIT/AMP FOLLICLE STIMULATING HORMONE STRENGTH: 150 UNITS: UNIT/AMP SODIUM CHLORIDE STRENGTH: 0.9 UNITS: %WV
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-19 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	FOLLICLE STIMULATING HORMONE/LUTEINIZING HORMONE INJ,SOLN
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4008074
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-19 00:00:00 STATUS: INACTIVE