CODEINE 10MG/GG 100MG/PSEUDEFED 30MG/5ML SYRUP (4102) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE 10MG/GG 100MG/PSEUDEFED 30MG/5ML SYRUP
VA GENERIC NAME	CODEINE/GUAIFENESIN/PSEUDOEPHEDRINE
DOSAGE FORM	SYRUP
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CODEINE PHOSPHATE STRENGTH: 10 UNITS: MG/5ML PSEUDOEPHEDRINE HYDROCHLORIDE STRENGTH: 30 UNITS: MG/5ML GUAIFENESIN STRENGTH: 100 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Schedule V
DSS NUMBER	1
NATIONAL FORMULARY NAME	CODEINE/GUAIFENESIN/PSEUDOEPHEDRINE 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/GG 100/PSEUDO 30MG/5ML SYRUP
VA PRODUCT IDENTIFIER	C0793
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4004655
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE