THEOPHYLLINE 1.6MG/ML/DEXTROSE 5% INJ (5776) VA PRODUCT (50.68)

Name	Value
NAME	THEOPHYLLINE 1.6MG/ML/DEXTROSE 5% INJ
VA GENERIC NAME	DEXTROSE/THEOPHYLLINE
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	DEXTROSE STRENGTH: 5 UNITS: % THEOPHYLLINE STRENGTH: 1.6 UNITS: MG/ML
CS FEDERAL SCHEDULE	Unscheduled
STRENGTH	1.6
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2017-02-14 00:00:00
UNITS	MG/ML
DSS NUMBER	3
NATIONAL FORMULARY NAME	DEXTROSE/THEOPHYLLINE INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE	NO
POSSIBLE DOSAGES TO CREATE	No Possible Dosages
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4006301
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE