ERYTHROMYCIN ESTOLATE 125MG CAP (977)    VA PRODUCT (50.68)

Name Value
NAME ERYTHROMYCIN ESTOLATE 125MG CAP
VA GENERIC NAME ERYTHROMYCIN
DOSAGE FORM CAP,ORAL
FORMULARY DESIGNATOR R
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 125
INACTIVATION DATE 2007-09-18 00:00:00
UNITS MG
DSS NUMBER 27
NATIONAL FORMULARY NAME ERYTHROMYCIN CAP,ORAL
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
VA PRINT NAME ERYTHROMYCIN ESTOLATE 125MG CAP
VA PRODUCT IDENTIFIER E0131
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4001581
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-09-18 00:00:00
    STATUS:   INACTIVE