| NAME |
KETOROLAC 0.5/PHENYLEPHRINE2.5/PROPARACAINE0.5/TROPICAMIDE 1%OPH |
| VA GENERIC NAME |
KETOROLAC/PHENYLEPHRINE/PROPARACAINE/TROPICAMIDE |
| DOSAGE FORM |
SOLN,OPH |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
KETOROLAC/PHENYLEPHRINE/PROPARACAINE/TROPICAMIDE SOLN,OPH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2023-01-25 00:00:00
- COPAY END DATE: 2023-01-25 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-01-26 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
MYDRIATIC-4 SOLN OPH |
| VA PRODUCT IDENTIFIER |
M1317 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041986 |
| EFFECTIVE DATE/TIME |
-
- 2023-01-25 00:00:00
- STATUS: ACTIVE
|
