| NAME |
AMPHOTERICIN B 25MG/TETRACYCLINE 125MG/5ML SYRUP |
| VA GENERIC NAME |
AMPHOTERICIN B/TETRACYCLINE |
| DOSAGE FORM |
SYRUP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2002-05-24 00:00:00 |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
AMPHOTERICIN B/TETRACYCLINE SYRUP |
| 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 |
AMPHOTERICIN B 25/TCN 125MG/5ML SYRUP |
| VA PRODUCT IDENTIFIER |
A0304 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4001741 |
| EFFECTIVE DATE/TIME |
-
- 2002-05-24 00:00:00
- STATUS: INACTIVE
-
- 2005-12-08 00:00:00
- STATUS: INACTIVE
|
