| NAME |
DICLOFENAC EPOLAMINE 1.3% PATCH |
| VA GENERIC NAME |
DICLOFENAC |
| DOSAGE FORM |
PATCH |
| FDA MED GUIDE |
NSAIDs_(Class)_(2022).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1.3 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
DICLOFENAC 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: 2019-03-17 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-03-18 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DICLOFENAC EPOLAMINE 1.3% PATCH |
| VA PRODUCT IDENTIFIER |
D0770 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4027239 |
| EFFECTIVE DATE/TIME |
-
- 2008-03-07 00:00:00
- STATUS: ACTIVE
|
