BROMPHENIRAMINE 1MG/DM 5MG/PHENYLEPHRINE 2.5MG/5ML LIQUID (26202) VA PRODUCT (50.68)

Name	Value
NAME	BROMPHENIRAMINE 1MG/DM 5MG/PHENYLEPHRINE 2.5MG/5ML LIQUID
VA GENERIC NAME	BROMPHENIRAMINE/DEXTROMETHORPHAN/PHENYLEPHRINE
DOSAGE FORM	LIQUID,ORAL
ACTIVE INGREDIENTS	BROMPHENIRAMINE STRENGTH: 1 UNITS: MG/5ML PHENYLEPHRINE STRENGTH: 2.5 UNITS: MG/5ML DEXTROMETHORPHAN STRENGTH: 5 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	BROMPHENIRAMINE/DEXTROMETHORPHAN/PHENYLEPHRINE LIQUID,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	BROMPHEN 1/DM 5/PHENYLEP 2.5MG/5ML LIQ
VA PRODUCT IDENTIFIER	B0780
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4034995
EFFECTIVE DATE/TIME	2015-10-29 00:00:00 STATUS: ACTIVE