| NAME |
GLYCOPYRROLATE 1MG/5ML SOLN,ORAL |
| VA GENERIC NAME |
GLYCOPYRROLATE |
| DOSAGE FORM |
SOLN,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/5ML |
| NATIONAL FORMULARY NAME |
GLYCOPYRROLATE SOLN,ORAL |
| 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: 2022-01-12 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-01-13 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
GLYCOPYRROLATE 1MG/5ML ORAL SOLN |
| VA PRODUCT IDENTIFIER |
G0379 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031698 |
| EFFECTIVE DATE/TIME |
-
- 2012-10-05 00:00:00
- STATUS: ACTIVE
|
