URINARY ANTISEPTIC W/METHENAMINE 118MG CAP,ORAL (25600) VA PRODUCT (50.68)

Name	Value
NAME	URINARY ANTISEPTIC W/METHENAMINE 118MG CAP,ORAL
VA GENERIC NAME	HYOSCYAMINE/METHENAMINE/METHYLENE/PHENYL SALICYL/SODIUM PHOS
DOSAGE FORM	CAP,ORAL
ACTIVE INGREDIENTS	METHENAMINE STRENGTH: 118 UNITS: MG METHYLENE BLUE STRENGTH: 10 UNITS: MG PHENYL SALICYLATE STRENGTH: 36 UNITS: MG SODIUM PHOSPHATE,MONOBASIC STRENGTH: 40.8 UNITS: MG HYOSCYAMINE SULFATE STRENGTH: 0.12 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	HYOSCYAMINE/METHENAMINE/METHYLENE/PHENYL SALICYL/SODIUM PHOS CAP,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	URINARY ANTISEPT W/METHENAMINE 118MG CAP
VA PRODUCT IDENTIFIER	U0077
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4034334
EFFECTIVE DATE/TIME	2015-04-07 00:00:00 STATUS: ACTIVE