DEXTROMETHORPHAN 5MG/PHENYLPROPANOLAMINE 6.25MG/5ML SYRUP (14199) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROMETHORPHAN 5MG/PHENYLPROPANOLAMINE 6.25MG/5ML SYRUP
VA GENERIC NAME	DEXTROMETHORPHAN/PHENYLPROPANOLAMINE
DOSAGE FORM	SYRUP
ACTIVE INGREDIENTS	PHENYLPROPANOLAMINE STRENGTH: 6.25 UNITS: MG/5ML DEXTROMETHORPHAN STRENGTH: 5 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2005-10-14 00:00:00
NATIONAL FORMULARY NAME	DEXTROMETHORPHAN/PHENYLPROPANOLAMINE SYRUP
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	DM 5/PHENYLPROPANOLAMINE6.25MG/5ML SYRUP
VA PRODUCT IDENTIFIER	D0505
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4014563
EFFECTIVE DATE/TIME	2002-04-04 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE