CODEINE 10MG/PHENYLEPHRINE 10MG/TRIPROLIDINE 2.5MG/5ML SYRUP (26016) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE 10MG/PHENYLEPHRINE 10MG/TRIPROLIDINE 2.5MG/5ML SYRUP
VA GENERIC NAME	CODEINE/PHENYLEPHRINE/TRIPROLIDINE
DOSAGE FORM	SYRUP
ACTIVE INGREDIENTS	TRIPROLIDINE HYDROCHLORIDE STRENGTH: 2.5 UNITS: MG/5ML PHENYLEPHRINE STRENGTH: 10 UNITS: MG/5ML CODEINE PHOSPHATE STRENGTH: 10 UNITS: MG/5ML
NATIONAL FORMULARY NAME	CODEINE/PHENYLEPHRINE/TRIPROLIDINE 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	YES
PGX SUPPRESSED	YES
VA PRINT NAME	CODEINE 10/P-EPHRNE 10/TRIPROL 2.5MG/5ML
VA PRODUCT IDENTIFIER	C1729
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4034795
EFFECTIVE DATE/TIME	2015-09-10 00:00:00 STATUS: ACTIVE