AMANTADINE HCL 50MG/5ML (SF) SYRUP,10ML (4648)    VA PRODUCT (50.68)

Name Value
NAME AMANTADINE HCL 50MG/5ML (SF) SYRUP,10ML
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
INACTIVATION DATE 2022-11-15 00:00:00
UNITS MG/5ML
DSS NUMBER 4
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 SF SYRUP 10ML
VA PRODUCT IDENTIFIER A0971
TRANSMIT TO CMOP YES
VA DISPENSE UNIT EA
MASTER ENTRY FOR VUID YES
VUID 4005195
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2022-11-15 00:00:00
    STATUS:   INACTIVE