| NAME |
HYDROXYAMPHETAMINE 1%/TROPICAMIDE 0.25% SOLN,OPH |
| VA GENERIC NAME |
HYDROXYAMPHETAMINE/TROPICAMIDE |
| DOSAGE FORM |
SOLN,OPH |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
HYDROXYAMPHETAMINE/TROPICAMIDE SOLN,OPH |
| 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: 2023-03-29 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-03-30 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
HYDROXYAMPHETAMINE 1/TROP 0.25% OPH SOLN |
| VA PRODUCT IDENTIFIER |
H0539 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4027358 |
| EFFECTIVE DATE/TIME |
-
- 2008-05-15 00:00:00
- STATUS: ACTIVE
|
