AMITRIPTYLINE HCL 10MG/PERPHENAZINE 4MG TAB (2299) VA PRODUCT (50.68)

Name	Value
NAME	AMITRIPTYLINE HCL 10MG/PERPHENAZINE 4MG TAB
VA GENERIC NAME	AMITRIPTYLINE/PERPHENAZINE
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	AMITRIPTYLINE HYDROCHLORIDE STRENGTH: 10 UNITS: MG PERPHENAZINE STRENGTH: 4 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	4
NATIONAL FORMULARY NAME	AMITRIPTYLINE/PERPHENAZINE TAB
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	YES
VA PRINT NAME	AMITRIPTYLINE 10/PERPHENAZINE 4MG TAB
VA PRODUCT IDENTIFIER	A0224
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4002882
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE