| NAME |
PHENTERMINE 15MG/TOPIRAMATE 92MG CAP,SA |
| VA GENERIC NAME |
PHENTERMINE/TOPIRAMATE |
| DOSAGE FORM |
CAP,SA |
| FDA MED GUIDE |
Phentermine_Topiramate_(Qsymia)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Schedule IV |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
PHENTERMINE/TOPIRAMATE CAP,SA |
| 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 |
PHENTERMINE 15/TOPIRAMATE 92MG SA CAP |
| VA PRODUCT IDENTIFIER |
P1010 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031595 |
| EFFECTIVE DATE/TIME |
-
- 2012-08-03 00:00:00
- STATUS: ACTIVE
|
