| NAME |
BRIMONIDINE TARTRATE 0.33% GEL,TOP |
| VA GENERIC NAME |
BRIMONIDINE |
| DOSAGE FORM |
GEL,TOP |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.33 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
BRIMONIDINE GEL,TOP |
| 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
- COPAY END DATE: 2021-02-03 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2021-02-04 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BRIMONIDINE TARTRATE 0.33% TOP GEL |
| VA PRODUCT IDENTIFIER |
B0727 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032693 |
| EFFECTIVE DATE/TIME |
-
- 2013-09-13 00:00:00
- STATUS: ACTIVE
|
