| NAME |
HYDROCODONE RESIN 5MG/PHENYLTOLOXAMINE RESIN 10MG TAB |
| VA GENERIC NAME |
HYDROCODONE/PHENYLTOLOXAMINE |
| DOSAGE FORM |
TAB |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Schedule II |
| INACTIVATION DATE |
2007-09-28 00:00:00 |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
HYDROCODONE/PHENYLTOLOXAMINE TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| TRANSMIT TO CMOP |
NO |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4003910 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2007-09-28 00:00:00
- STATUS: INACTIVE
|
