| NAME |
THEOPHYLLINE 150MG/15ML SYRUP |
| VA GENERIC NAME |
THEOPHYLLINE |
| DOSAGE FORM |
SYRUP |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY RESTRICTION |
Refer to VA/DoD COPD treatment guidelines
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
150 |
| INACTIVATION DATE |
2007-09-25 00:00:00 |
| UNITS |
MG/15ML |
| DSS NUMBER |
49 |
| NATIONAL FORMULARY NAME |
THEOPHYLLINE SYRUP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 |
4003694 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2007-09-25 00:00:00
- STATUS: INACTIVE
|
