| NAME |
NITROGLYCERIN 0.4% OINT,RTL |
| VA GENERIC NAME |
NITROGLYCERIN |
| DOSAGE FORM |
OINT,RTL |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to GI and surgery and a dispensing limit of one 30-g tube per month
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.4 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
NITROGLYCERIN OINT,RTL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| 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 |
NITROGLYCERIN 0.4% RTL OINT |
| VA PRODUCT IDENTIFIER |
N0645 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031416 |
| EFFECTIVE DATE/TIME |
-
- 2012-05-07 00:00:00
- STATUS: ACTIVE
|
