GUAIFENESIN 100MG/THEOPHYLLINE 125MG/15ML SYRUP (5076) VA PRODUCT (50.68)

Name	Value
NAME	GUAIFENESIN 100MG/THEOPHYLLINE 125MG/15ML SYRUP
VA GENERIC NAME	GUAIFENESIN/THEOPHYLLINE
DOSAGE FORM	LIQUID
ACTIVE INGREDIENTS	THEOPHYLLINE STRENGTH: 125 UNITS: MG/15ML GUAIFENESIN STRENGTH: 100 UNITS: MG/15ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2003-07-31 00:00:00
DSS NUMBER	9
NATIONAL FORMULARY NAME	GUAIFENESIN/THEOPHYLLINE LIQUID
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	GG 100/THEOPHYLLINE 125MG/15ML SYRUP
VA PRODUCT IDENTIFIER	G0089
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4005617
EFFECTIVE DATE/TIME	2003-07-31 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE