AMPHOTERICIN B 50MG/TETRACYCLINE HCL 250MG CAP (1140) VA PRODUCT (50.68)

Name	Value
NAME	AMPHOTERICIN B 50MG/TETRACYCLINE HCL 250MG CAP
VA GENERIC NAME	AMPHOTERICIN B/TETRACYCLINE
DOSAGE FORM	CAP,ORAL
ACTIVE INGREDIENTS	AMPHOTERICIN B STRENGTH: 50 UNITS: MG TETRACYCLINE HYDROCHLORIDE STRENGTH: 250 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2002-05-24 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	AMPHOTERICIN B/TETRACYCLINE CAP,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
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 50/TETRACYCLINE 250MG CAP
VA PRODUCT IDENTIFIER	A0288
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4001742
EFFECTIVE DATE/TIME	2002-05-24 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE