AMOXICILLIN 125MG/CLAVULANATE K 31.25MG/5ML SUSP (4126) VA PRODUCT (50.68)

Name	Value
NAME	AMOXICILLIN 125MG/CLAVULANATE K 31.25MG/5ML SUSP
VA GENERIC NAME	AMOXICILLIN/CLAVULANATE
DOSAGE FORM	PWDR,RENST-ORAL
FORMULARY DESIGNATOR	R
ACTIVE INGREDIENTS	CLAVULANATE POTASSIUM STRENGTH: 31.25 UNITS: MG/5ML AMOXICILLIN STRENGTH: 125 UNITS: MG/5ML
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	11
NATIONAL FORMULARY NAME	AMOXICILLIN/CLAVULANATE PWDR,RENST-ORAL
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	AMOXICILLIN 125/CLAV K 31.25MG/5ML SUSP
VA PRODUCT IDENTIFIER	A0258
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4004678
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE