AMANTADINE HCL 50MG/5ML SYRUP (4646)    VA PRODUCT (50.68)

Name Value
NAME AMANTADINE HCL 50MG/5ML SYRUP
VA GENERIC NAME AMANTADINE
DOSAGE FORM SYRUP
FORMULARY DESIGNATOR R
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
NATIONAL FORMULARY RESTRICTION 
Refer to HIV/AIDS TAG treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 50
SINGLE/MULTI SOURCE PRODUCT Multisource
UNITS MG/5ML
DSS NUMBER 2
NATIONAL FORMULARY NAME AMANTADINE SYRUP
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 AMANTADINE HCL 50MG/5ML SYRUP
VA PRODUCT IDENTIFIER A0187
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4005193
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2021-10-18 00:00:00
    STATUS:   INACTIVE
  • 2021-10-18 00:00:00
    STATUS:   INACTIVE
  • 2021-10-18 00:00:00
    STATUS:   INACTIVE
  • 2021-10-18 00:00:00
    STATUS:   INACTIVE
  • 2022-08-15 00:00:00
    STATUS:   ACTIVE