DEXTROMETHORPHAN 10MG/GUAIFENESIN 200MG CAP (25265) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROMETHORPHAN 10MG/GUAIFENESIN 200MG CAP
VA GENERIC NAME	DEXTROMETHORPHAN/GUAIFENESIN
DOSAGE FORM	CAP,ORAL
ACTIVE INGREDIENTS	DEXTROMETHORPHAN HYDROBROMIDE STRENGTH: 10 UNITS: MG GUAIFENESIN STRENGTH: 200 UNITS: MG
NATIONAL FORMULARY NAME	DEXTROMETHORPHAN/GUAIFENESIN 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	DM 10/GUAIFENESIN 200MG CAP
VA PRODUCT IDENTIFIER	D1073
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4033959
EFFECTIVE DATE/TIME	2014-12-18 00:00:00 STATUS: ACTIVE