HYDROXYZINE HCL 10MG/PENTAERYTHRITOL TETRANITRATE 10MG TAB (4517) VA PRODUCT (50.68)

Name	Value
NAME	HYDROXYZINE HCL 10MG/PENTAERYTHRITOL TETRANITRATE 10MG TAB
VA GENERIC NAME	HYDROXYZINE/PENTAERYTHRITOL TETRANITRATE
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	PENTAERYTHRITOL TETRANITRATE STRENGTH: 20 UNITS: MG HYDROXYZINE HYDROCHLORIDE STRENGTH: 10 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2002-09-30 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	HYDROXYZINE/PENTAERYTHRITOL TETRANITRATE TAB
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4005064
EFFECTIVE DATE/TIME	2002-09-30 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE