HELIDAC THERAPY PACK (12611) VA PRODUCT (50.68)

Name	Value
NAME	HELIDAC THERAPY PACK
VA GENERIC NAME	BISMUTH SUBSALICYLATE/METRONIDAZOLE/TETRACYCLINE
DOSAGE FORM	MISCELLANEOUS
ACTIVE INGREDIENTS	BISMUTH SUBSALICYLATE STRENGTH: 112 X 262.4 UNITS: MG TETRACYCLINE HYDROCHLORIDE STRENGTH: 56 X 500 UNITS: MG METRONIDAZOLE STRENGTH: 56 X 250 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2022-01-15 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	BISMUTH SUBSALICYLATE/METRONIDAZOLE/TETRACYCLINE MISCELLANEOUS
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	HELIDAC THERAPY PACK
VA PRODUCT IDENTIFIER	H0260
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKG
MASTER ENTRY FOR VUID	YES
VUID	4012976
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2020-08-07 00:00:00 STATUS: ACTIVE 2022-01-15 00:00:00 STATUS: INACTIVE