GUAIFENESIN 200MG/HYDROCODONE 2.5MG/PSEUDEFED 30MG/5ML LIQUID (25966) VA PRODUCT (50.68)

Name	Value
NAME	GUAIFENESIN 200MG/HYDROCODONE 2.5MG/PSEUDEFED 30MG/5ML LIQUID
VA GENERIC NAME	GUAIFENESIN/HYDROCODONE/PSEUDOEPHEDRINE
DOSAGE FORM	SOLN,ORAL
ACTIVE INGREDIENTS	HYDROCODONE BITARTRATE STRENGTH: 2.5 UNITS: MG/5ML PSEUDOEPHEDRINE STRENGTH: 30 UNITS: MG/5ML GUAIFENESIN STRENGTH: 200 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Schedule II
INACTIVATION DATE	2018-08-15 00:00:00
NATIONAL FORMULARY NAME	GUAIFENESIN/HYDROCODONE/PSEUDOEPHEDRINE SOLN,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2018-05-31 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2018-06-01 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	HYDOCODONE2.5/GUAIF200/PSEUD30MG/5ML LIQ
VA PRODUCT IDENTIFIER	H0684
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4034740
EFFECTIVE DATE/TIME	2015-08-20 00:00:00 STATUS: ACTIVE 2018-08-15 00:00:00 STATUS: INACTIVE