ASPIRIN 25MG/DIPYRIDAMOLE 200MG CAP,SA (14128)    VA PRODUCT (50.68)

Name Value
NAME ASPIRIN 25MG/DIPYRIDAMOLE 200MG CAP,SA
VA GENERIC NAME ASPIRIN/DIPYRIDAMOLE
DOSAGE FORM CAP,SA
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT
Restriction: Initial prescription should be made by a Neurologist
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME ASPIRIN/DIPYRIDAMOLE CAP,SA
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 ASPIRIN 25MG/DIPYRIDAMOLE 200MG SA CAP
VA PRODUCT IDENTIFIER A1044
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4014492
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE