| NAME |
THEOPHYLLINE 400MG CAP,SA (THEO-24) |
| VA GENERIC NAME |
THEOPHYLLINE |
| DOSAGE FORM |
CAP,SA |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
400 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| DSS NUMBER |
109 |
| NATIONAL FORMULARY NAME |
THEOPHYLLINE CAP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| 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-24) 400MG SA CAP |
| VA PRODUCT IDENTIFIER |
T0304 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003749 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
