BELLADONNA ALKALOIDS 0.1296MG/PHENOBARBITAL 16.2MG LIQUID (4078) VA PRODUCT (50.68)

Name	Value
NAME	BELLADONNA ALKALOIDS 0.1296MG/PHENOBARBITAL 16.2MG LIQUID
VA GENERIC NAME	ATROPINE/HYOSCYAMINE/PHENOBARBITAL/SCOPOLAMINE
DOSAGE FORM	LIQUID
ACTIVE INGREDIENTS	ATROPINE SULFATE STRENGTH: 0.0194 UNITS: MG PHENOBARBITAL STRENGTH: 16.2 UNITS: MG HYOSCYAMINE SULFATE STRENGTH: 0.1037 UNITS: MG SCOPOLAMINE HYDROBROMIDE STRENGTH: 0.0065 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	13
NATIONAL FORMULARY NAME	ATROPINE/HYOSCYAMINE/PHENOBARBITAL/SCOPOLAMINE LIQUID
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2018-05-31 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2018-06-01 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	BELLADONNA ALK 0.13/PHENOBARB 16MG/5ML
VA PRODUCT IDENTIFIER	B0331
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4004631
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE