THEOPHYLLINE 100MG CAP,SA (SLO-BID GYROCAPS) (3142)    VA PRODUCT (50.68)

Name Value
NAME THEOPHYLLINE 100MG CAP,SA (SLO-BID GYROCAPS)
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
INACTIVATION DATE 2003-04-16 00:00:00
UNITS MG
DSS NUMBER 72
NATIONAL FORMULARY NAME THEOPHYLLINE CAP,SA
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
VA PRINT NAME THEOPHYLLINE (SLO-BID) 100MG SA CAP
VA PRODUCT IDENTIFIER T0267
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4003712
EFFECTIVE DATE/TIME
  • 2003-04-16 00:00:00
    STATUS:   INACTIVE
  • 2005-12-08 00:00:00
    STATUS:   INACTIVE