| NAME |
THEOPHYLLINE,ANHYDROUS 80MG/15ML (SF) ELIXIR |
| VA GENERIC NAME |
THEOPHYLLINE |
| DOSAGE FORM |
ELIXIR |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
80 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/15ML |
| DSS NUMBER |
59 |
| NATIONAL FORMULARY NAME |
THEOPHYLLINE ELIXIR |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2019-04-17 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-04-18 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
THEOPHYLLINE 80MG/15ML (SF) ELIXIR |
| VA PRODUCT IDENTIFIER |
T0317 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003703 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
