PREVPAC PATIENT THERAPY PAK (12862) VA PRODUCT (50.68)

Name	Value
NAME	PREVPAC PATIENT THERAPY PAK
VA GENERIC NAME	AMOXICILLIN/CLARITHROMYCIN/LANSOPRAZOLE
DOSAGE FORM	MISCELLANEOUS
ACTIVE INGREDIENTS	AMOXICILLIN TRIHYDRATE STRENGTH: 56 X 500 UNITS: MG CLARITHROMYCIN STRENGTH: 28 X 500 UNITS: MG LANSOPRAZOLE STRENGTH: 28 X 30 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMOXICILLIN/CLARITHROMYCIN/LANSOPRAZOLE 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	YES
PGX SUPPRESSED	NO
VA PRINT NAME	PREVPAC PATIENT THERAPY PAK
VA PRODUCT IDENTIFIER	P0496
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	PKT
MASTER ENTRY FOR VUID	YES
VUID	4013227
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE