THEOPHYLLINE 4MG/ML/DEXTROSE 5% INJ (5778) VA PRODUCT (50.68)

Name	Value
NAME	THEOPHYLLINE 4MG/ML/DEXTROSE 5% INJ
VA GENERIC NAME	DEXTROSE/THEOPHYLLINE
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	DEXTROSE STRENGTH: 5 UNITS: % THEOPHYLLINE STRENGTH: 4 UNITS: MG/ML
CS FEDERAL SCHEDULE	Unscheduled
STRENGTH	4
INACTIVATION DATE	2009-05-20 00:00:00
UNITS	MG/ML
DSS NUMBER	5
NATIONAL FORMULARY NAME	DEXTROSE/THEOPHYLLINE 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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4006303
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2009-05-20 00:00:00 STATUS: INACTIVE