DEXTROMETHORPHAN 15/DOXYLAMINE 6.25/PSEUDOFEDRINE 30MG/5ML LIQ (27190) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROMETHORPHAN 15/DOXYLAMINE 6.25/PSEUDOFEDRINE 30MG/5ML LIQ
VA GENERIC NAME	DEXTROMETHORPHAN/DOXYLAMINE/PSEUDOEPHEDRINE
DOSAGE FORM	LIQUID,ORAL
ACTIVE INGREDIENTS	PSEUDOEPHEDRINE STRENGTH: 30 UNITS: MG/5ML DOXYLAMINE SUCCINATE STRENGTH: 6.25 UNITS: MG/5ML DEXTROMETHORPHAN HYDROBROMIDE STRENGTH: 15 UNITS: MG/5ML
NATIONAL FORMULARY NAME	DEXTROMETHORPHAN/DOXYLAMINE/PSEUDOEPHEDRINE 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	DM 15/DOXYLAMINE 6.25/PSEUDO 30/5ML LIQ
VA PRODUCT IDENTIFIER	D1137
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4036077
EFFECTIVE DATE/TIME	2016-09-29 00:00:00 STATUS: ACTIVE