URINARY ANTISEPTIC W/METHENAMINE 82MG TAB (4914) VA PRODUCT (50.68)

Name	Value
NAME	URINARY ANTISEPTIC W/METHENAMINE 82MG TAB
VA GENERIC NAME	HYOSCYAMINE/METHAMINE/METHYLENE BLUE/PHENYL SALICYLATE/SODIUM BI
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	METHENAMINE STRENGTH: 81.6 UNITS: MG METHYLENE BLUE STRENGTH: 10.8 UNITS: MG PHENYL SALICYLATE STRENGTH: 36.2 UNITS: MG BENZOIC ACID STRENGTH: 9 UNITS: MG SODIUM BIPHOSPHATE STRENGTH: 40.8 UNITS: MG HYOSCYAMINE SULFATE STRENGTH: 0.12 UNITS: MG HYOSCYAMINE STRENGTH: 0.06 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
INACTIVATION DATE	2004-11-19 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	HYOSCYAMINE/METHAMINE/METHYLENE BLUE/PHENYL SALICYLATE/SODIUM BI TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	URINARY ANTISEPT W/METHENAMINE 82MG TAB
VA PRODUCT IDENTIFIER	U0026
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	NO
VUID	4005455
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2008-09-03 00:00:00 STATUS: INACTIVE 2004-11-19 00:00:00 STATUS: INACTIVE 2008-11-06 00:00:00 STATUS: ACTIVE