THEOPHYLLINE 200MG TAB,SA (THEO-SAV) (3173)    VA PRODUCT (50.68)

Name Value
NAME THEOPHYLLINE 200MG TAB,SA (THEO-SAV)
VA GENERIC NAME THEOPHYLLINE
DOSAGE FORM TAB,SA
ACTIVE INGREDIENTS
NATIONAL FORMULARY RESTRICTION 
Refer to VA/DoD COPD treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 200
INACTIVATION DATE 2007-09-25 00:00:00
UNITS MG
DSS NUMBER 103
NATIONAL FORMULARY NAME THEOPHYLLINE TAB,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 (THEO-SAV) 200MG SA TAB
VA PRODUCT IDENTIFIER T0298
TRANSMIT TO CMOP NO
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4003743
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-25 00:00:00
    STATUS:   INACTIVE