B-DONNA 5MG/METHENAMINE MAND 250MG/SALICYLAMIDE 120MG TAB (6938) VA PRODUCT (50.68)

Name	Value
NAME	B-DONNA 5MG/METHENAMINE MAND 250MG/SALICYLAMIDE 120MG TAB
VA GENERIC NAME	BELLADONNA/METHENAMINE/SALICYLAMIDE
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	BELLADONNA STRENGTH: 5 UNITS: MG SALICYLAMIDE STRENGTH: 120 UNITS: MG METHENAMINE MANDELATE STRENGTH: 250 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2008-09-02 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	BELLADONNA/METHENAMINE/SALICYLAMIDE 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	NO
PGX SUPPRESSED	NO
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4007450
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2008-09-02 00:00:00 STATUS: INACTIVE