| NAME |
FENTANYL 87.5MCG/HR PATCH |
| VA GENERIC NAME |
FENTANYL |
| DOSAGE FORM |
PATCH |
| FDA MED GUIDE |
Fentanyl_Patch_(Generic)_(2020).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Schedule II |
| STRENGTH |
87.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MCG/HR |
| NATIONAL FORMULARY NAME |
FENTANYL PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
FENTANYL 87.5MCG/HR PATCH |
| VA PRODUCT IDENTIFIER |
F0558 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034258 |
| EFFECTIVE DATE/TIME |
-
- 2015-03-10 00:00:00
- STATUS: ACTIVE
|
