AMITRIPTYLINE HCL 12.5MG/CHLORDIAZEPOXIDE 5MG TAB (6425) VA PRODUCT (50.68)

Name	Value
NAME	AMITRIPTYLINE HCL 12.5MG/CHLORDIAZEPOXIDE 5MG TAB
VA GENERIC NAME	AMITRIPTYLINE/CHLORDIAZEPOXIDE
DOSAGE FORM	TAB
FDA MED GUIDE	Amitriptyline-Chlordiazepoxide_(Generic)_(2022).pdf
ACTIVE INGREDIENTS	AMITRIPTYLINE HYDROCHLORIDE STRENGTH: 12.5 UNITS: MG CHLORDIAZEPOXIDE STRENGTH: 5 UNITS: MG
CS FEDERAL SCHEDULE	Schedule IV
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMITRIPTYLINE/CHLORDIAZEPOXIDE 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
PGX ELIGIBLE	YES
PGX SUPPRESSED	YES
VA PRINT NAME	AMITRIPTYLIN 12.5/CHLORDIAZEPOXID 5MG TB
VA PRODUCT IDENTIFIER	A0660
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4006945
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE