| NAME |
SCOPOLAMINE 0.33MG/24HRS PATCH |
| VA GENERIC NAME |
SCOPOLAMINE |
| DOSAGE FORM |
PATCH |
| FDA MED GUIDE |
Scopolamine_Patch_(Generic)_(2019).pdf |
| FORMULARY DESIGNATOR TEXT |
Dispensing limited to 4 patches with no refills for indication of post-op N/V.. These quantity limitations do not apply to other indications
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.33 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/24HRS |
| NATIONAL FORMULARY NAME |
SCOPOLAMINE PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2017-11-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-12-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SCOPOLAMINE 0.33MG/24HR (1MG/3DAY) PATCH |
| VA PRODUCT IDENTIFIER |
S0958 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4013254 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
