THEOPHYLLINE 100MG/18.75ML SOLN,ORAL (3085)    VA PRODUCT (50.68)

Name Value
NAME THEOPHYLLINE 100MG/18.75ML SOLN,ORAL
VA GENERIC NAME THEOPHYLLINE
DOSAGE FORM SOLN,ORAL
ACTIVE INGREDIENTS
NATIONAL FORMULARY RESTRICTION 
Refer to VA/DoD COPD treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 100
INACTIVATION DATE 2008-09-02 00:00:00
UNITS MG/18.75ML
DSS NUMBER 14
NATIONAL FORMULARY NAME THEOPHYLLINE SOLN,ORAL
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
TRANSMIT TO CMOP NO
MASTER ENTRY FOR VUID YES
VUID 4003659
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-25 00:00:00
    STATUS:   INACTIVE
  • 2007-10-10 00:00:00
    STATUS:   ACTIVE
  • 2008-09-02 00:00:00
    STATUS:   INACTIVE