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    NDC 42292-0040-20 Levothyroxine Sodium 175 ug/1 Details

    Levothyroxine Sodium 175 ug/1

    Levothyroxine Sodium is a ORAL TABLET in the HUMAN PRESCRIPTION DRUG category. It is labeled and distributed by Mylan Institutional Inc.. The primary component is LEVOTHYROXINE SODIUM.

    Product Information

    NDC 42292-0040
    Product ID 42292-040_f4348cfd-4241-bfd4-e053-2995a90ab7ad
    Associated GPIs 28100010100335
    GCN Sequence Number 006655
    GCN Sequence Number Description levothyroxine sodium TABLET 175 MCG ORAL
    HIC3 P3A
    HIC3 Description THYROID HORMONES
    GCN 26328
    HICL Sequence Number 002849
    HICL Sequence Number Description LEVOTHYROXINE SODIUM
    Brand/Generic Generic
    Proprietary Name Levothyroxine Sodium
    Proprietary Name Suffix n/a
    Non-Proprietary Name levothyroxine sodium
    Product Type HUMAN PRESCRIPTION DRUG
    Dosage Form TABLET
    Route ORAL
    Active Ingredient Strength 175
    Active Ingredient Units ug/1
    Substance Name LEVOTHYROXINE SODIUM
    Labeler Name Mylan Institutional Inc.
    Pharmaceutical Class Thyroxine [CS], l-Thyroxine [EPC]
    DEA Schedule n/a
    Marketing Category ANDA
    Application Number ANDA076187
    Listing Certified Through 2024-12-31

    Package

    NDC 42292-0040-20 (42292004020)

    NDC Package Code 42292-040-20
    Billing NDC 42292004020
    Package 100 BLISTER PACK in 1 CARTON (42292-040-20) / 1 TABLET in 1 BLISTER PACK (42292-040-01)
    Marketing Start Date 2017-01-19
    NDC Exclude Flag N
    Pricing Information
    Price Per Unit 0.11223
    Pricing Unit EA
    Effective Date 2024-02-21
    NDC Description LEVOTHYROXINE 175 MCG TABLET
    Pharmacy Type Indicator C/I
    OTC N
    Explanation Code 1
    Classification for Rate Setting G
    As of Date 2024-02-21
    This pricing file, entitled the NADAC (National Average Drug Acquisition Cost) files, provide state Medicaid agencies with covered outpatient drug prices by averaging survey invoice prices from retail community pharmacies across the United States. These pharmacies include independent retail community pharmacies and chain pharmacies. The prices are updated on a weekly and monthly basis