| NAME |
NICOTINE 21MG/24HRS PATCH |
| VA GENERIC NAME |
NICOTINE |
| DOSAGE FORM |
PATCH |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY RESTRICTION |
RESTRICTED TO SMOKING CESSATION PROGRAMS
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
21 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG/24HRS |
| DSS NUMBER |
4 |
| NATIONAL FORMULARY NAME |
NICOTINE 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 |
NICOTINE 21MG/24HR PATCH |
| VA PRODUCT IDENTIFIER |
N0503 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4010106 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
