ASA 770MG/CAFN 60MG/ORPHENADRINE CITRATE 50MG TAB (6181) VA PRODUCT (50.68)

Name	Value
NAME	ASA 770MG/CAFN 60MG/ORPHENADRINE CITRATE 50MG TAB
VA GENERIC NAME	ASPIRIN/CAFFEINE/ORPHENADRINE
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	ASPIRIN STRENGTH: 770 UNITS: MG CAFFEINE STRENGTH: 60 UNITS: MG ORPHENADRINE CITRATE STRENGTH: 50 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	2
NATIONAL FORMULARY NAME	ASPIRIN/CAFFEINE/ORPHENADRINE TAB
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2019-04-24 00:00:00 COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2019-04-25 00:00:00 COPAY END DATE: 2019-07-31 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2019-08-01 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	ASA 770/CAFF 60/ORPHENADRINE 50MG TAB
VA PRODUCT IDENTIFIER	A1013
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4006702
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2019-05-01 00:00:00 STATUS: ACTIVE