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NDC 75854-0602-28 Balcoltra Details
Balcoltra
Balcoltra is a KIT in the HUMAN PRESCRIPTION DRUG category. It is labeled and distributed by Avion Pharmaceuticals. The primary component is .
Product Information
| NDC | 75854-0602 |
|---|---|
| Product ID | 75854-602_0ca934cf-a654-435c-ad1e-73fd7c563318 |
| Associated GPIs | 25990003350320 |
| GCN Sequence Number | 078077 |
| GCN Sequence Number Description | levonorgest/eth.estradiol/iron TABLET 0.1-0.02MG ORAL |
| HIC3 | G8A |
| HIC3 Description | CONTRACEPTIVES,ORAL |
| GCN | 44336 |
| HICL Sequence Number | 044733 |
| HICL Sequence Number Description | LEVONORGESTREL/ETHINYL ESTRADIOL/IRON |
| Brand/Generic | Brand |
| Proprietary Name | Balcoltra |
| Proprietary Name Suffix | n/a |
| Non-Proprietary Name | levonorgestrel and ethinyl estradiol |
| Product Type | HUMAN PRESCRIPTION DRUG |
| Dosage Form | KIT |
| Route | n/a |
| Active Ingredient Strength | n/a |
| Active Ingredient Units | n/a |
| Substance Name | n/a |
| Labeler Name | Avion Pharmaceuticals |
| Pharmaceutical Class | n/a |
| DEA Schedule | n/a |
| Marketing Category | NDA |
| Application Number | NDA208612 |
| Listing Certified Through | 2024-12-31 |
Package
NDC 75854-0602-28 (75854060228)
| NDC Package Code | 75854-602-28 |
|---|---|
| Billing NDC | 75854060228 |
| Package | 1 BLISTER PACK in 1 CARTON (75854-602-28) / 1 KIT in 1 BLISTER PACK |
| Marketing Start Date | 2018-04-10 |
| NDC Exclude Flag | N |
| Pricing Information | |
| Price Per Unit | 9.40226 |
| Pricing Unit | EA |
| Effective Date | 2024-01-01 |
| NDC Description | BALCOLTRA TABLET |
| Pharmacy Type Indicator | C/I |
| OTC | N |
| Explanation Code | 4 |
| Classification for Rate Setting | B |
| 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