| NAME |
GLYCOPYRRONIUM TOSYLATE 2.4% WIPE |
| VA GENERIC NAME |
GLYCOPYRRONIUM |
| DOSAGE FORM |
WIPE |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
2.4 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
GLYCOPYRRONIUM WIPE |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2019-03-18 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
GLYCOPYRRONIUM TOSYLATE 2.4% WIPE |
| VA PRODUCT IDENTIFIER |
G0464 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038212 |
| EFFECTIVE DATE/TIME |
-
- 2019-03-18 00:00:00
- STATUS: ACTIVE
|
