CODEINE 10MG/GG 100MG/PSEUDEFED 30MG/5ML (SF) LIQUID (4105) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE 10MG/GG 100MG/PSEUDEFED 30MG/5ML (SF) LIQUID
VA GENERIC NAME	CODEINE/GUAIFENESIN/PSEUDOEPHEDRINE
DOSAGE FORM	SYRUP
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CODEINE STRENGTH: 10 UNITS: MG/5ML ALCOHOL STRENGTH: 12 UNITS: % METHYLPARABEN STRENGTH: 0.1 UNITS: % 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
SINGLE/MULTI SOURCE PRODUCT	Multisource
INACTIVATION DATE	2004-11-18 00:00:00
DSS NUMBER	5
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	CODEINE10/GG100/P-EPHED 30MG/ML SF LIQ
VA PRODUCT IDENTIFIER	C1415
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	NO
VUID	4004658
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2004-11-18 00:00:00 STATUS: INACTIVE