URINARY ANTISEPTIC W/METHENAMINE 40.8MG TAB (4911) VA PRODUCT (50.68)

Name	Value
NAME	URINARY ANTISEPTIC W/METHENAMINE 40.8MG TAB
VA GENERIC NAME	ATROPINE/BENZOIC/HYOSCYAMINE/METHENAMINE/METHYLENE/PHENYL
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	ATROPINE SULFATE STRENGTH: 0.03 UNITS: MG METHENAMINE STRENGTH: 40.8 UNITS: MG METHYLENE BLUE STRENGTH: 5.4 UNITS: MG PHENYL SALICYLATE STRENGTH: 18.1 UNITS: MG BENZOIC ACID STRENGTH: 4.5 UNITS: MG HYOSCYAMINE SULFATE STRENGTH: 0.03 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2009-12-01 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ATROPINE/BENZOIC/HYOSCYAMINE/METHENAMINE/METHYLENE/PHENYL 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
VA PRINT NAME	URINARY ANTISEPT W/METHENAMIN 40.8MG TAB
VA PRODUCT IDENTIFIER	U0005
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4005452
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2009-12-01 00:00:00 STATUS: INACTIVE