| NAME |
MEMANTINE HCL 7MG/14MG/21MG/28MG CAP,SA TITRATION PACK,28 |
| VA GENERIC NAME |
MEMANTINE |
| DOSAGE FORM |
CAP,SA |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
MEMANTINE 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 |
MEMANTINE 7/14/21/28MG SA CAP PACK,28 |
| VA PRODUCT IDENTIFIER |
M1053 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032398 |
| EFFECTIVE DATE/TIME |
-
- 2013-05-22 00:00:00
- STATUS: ACTIVE
|
