BRETYLIUM TOSYLATE 2MG/ML/DEXTROSE 5% INJ,BAG,250ML (5772) VA PRODUCT (50.68)

Name	Value
NAME	BRETYLIUM TOSYLATE 2MG/ML/DEXTROSE 5% INJ,BAG,250ML
VA GENERIC NAME	BRETYLIUM/DEXTROSE
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	BRETYLIUM TOSYLATE STRENGTH: 2 UNITS: MG/ML DEXTROSE STRENGTH: 5 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
STRENGTH	2
INACTIVATION DATE	2004-07-29 00:00:00
UNITS	MG/ML
DSS NUMBER	3
NATIONAL FORMULARY NAME	BRETYLIUM/DEXTROSE INJ,SOLN
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	BRETYLIUM 2MG/ML D5W INJ BAG 250ML
VA PRODUCT IDENTIFIER	B0297
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4006297
EFFECTIVE DATE/TIME	2004-07-29 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE