| NAME |
TESTOSTERONE (ANDRODERM) 5MG/24HRS PATCH |
| VA GENERIC NAME |
TESTOSTERONE |
| DOSAGE FORM |
PATCH |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Schedule III Non-Narcotics |
| STRENGTH |
5 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| INACTIVATION DATE |
2016-10-21 00:00:00 |
| UNITS |
MG/24HRS |
| NATIONAL FORMULARY NAME |
TESTOSTERONE PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TESTOSTERONE (ANDRODERM) 5MG/24HRS PATCH |
| VA PRODUCT IDENTIFIER |
T0529 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4015871 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
