DIPHENHYDRAMINE 12.5MG/PHENYLEPHRINE 5MG/5ML LIQUID,ORAL (28742) VA PRODUCT (50.68)

Name	Value
NAME	DIPHENHYDRAMINE 12.5MG/PHENYLEPHRINE 5MG/5ML LIQUID,ORAL
VA GENERIC NAME	DIPHENHYDRAMINE/PHENYLEPHRINE
DOSAGE FORM	LIQUID,ORAL
ACTIVE INGREDIENTS	DIPHENHYDRAMINE STRENGTH: 12.5 UNITS: MG/5ML PHENYLEPHRINE STRENGTH: 5 UNITS: MG/5ML
NATIONAL FORMULARY NAME	DIPHENHYDRAMINE/PHENYLEPHRINE LIQUID,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2018-09-06 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	DIPHENHYDRA 12.5/P-EPHRINE 5MG/5ML LIQ
VA PRODUCT IDENTIFIER	D1189
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4037802
EFFECTIVE DATE/TIME	2018-09-06 00:00:00 STATUS: ACTIVE