THEOPHYLLINE 100MG CAP,SA (THEO-24) (3134)    VA PRODUCT (50.68)

Name Value
NAME THEOPHYLLINE 100MG CAP,SA (THEO-24)
VA GENERIC NAME THEOPHYLLINE
DOSAGE FORM CAP,SA
ACTIVE INGREDIENTS
NATIONAL FORMULARY RESTRICTION 
Refer to VA/DoD COPD treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 100
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS MG
DSS NUMBER 64
NATIONAL FORMULARY NAME THEOPHYLLINE CAP, SA
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 THEOPHYLLINE (THEO-24) 100MG SA CAP
VA PRODUCT IDENTIFIER T0257
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4003704
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-27 00:00:00
    STATUS:   INACTIVE
  • 2007-10-10 00:00:00
    STATUS:   ACTIVE
  • 2008-07-01 00:00:00
    STATUS:   INACTIVE
  • 2008-11-06 00:00:00
    STATUS:   ACTIVE