| NAME |
SELEGILINE 12MG/24HR PATCH |
| VA GENERIC NAME |
SELEGILINE |
| DOSAGE FORM |
PATCH |
| FDA MED GUIDE |
Selegiline_Patch_(Emsam)_(2017).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to psychiatry/mental health providers
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
12 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/24HRS |
| NATIONAL FORMULARY NAME |
SELEGILINE PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SELEGILINE 12MG/24HR PATCH |
| VA PRODUCT IDENTIFIER |
S0457 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4025313 |
| EFFECTIVE DATE/TIME |
-
- 2006-07-20 00:00:00
- STATUS: ACTIVE
|
