| NAME |
DEXTROAMPHETAMINE 4.5MG/9HR PATCH |
| VA GENERIC NAME |
DEXTROAMPHETAMINE |
| DOSAGE FORM |
PATCH |
| FDA MED GUIDE |
Dextroamphetamine_Patch_(Xelstrym)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Schedule II Non-Narcotics |
| STRENGTH |
4.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/9HR |
| NATIONAL FORMULARY NAME |
DEXTROAMPHETAMINE PATCH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-11-03 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DEXTROAMPHETAMINE 4.5MG/9HR PATCH |
| VA PRODUCT IDENTIFIER |
D1298 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041786 |
| EFFECTIVE DATE/TIME |
-
- 2022-11-03 00:00:00
- STATUS: ACTIVE
|
