EPHEDRINE 18.75MG/HYDROXYZINE 7.5MG/THEOPHYLLINE 97.5MG/15ML SYR (4516) VA PRODUCT (50.68)

Name	Value
NAME	EPHEDRINE 18.75MG/HYDROXYZINE 7.5MG/THEOPHYLLINE 97.5MG/15ML SYR
VA GENERIC NAME	EPHEDRINE/HYDROXYZINE/THEOPHYLLINE
DOSAGE FORM	SYRUP
ACTIVE INGREDIENTS	ALCOHOL,ETHYL STRENGTH: 5 UNITS: % HYDROXYZINE HYDROCHLORIDE STRENGTH: 7.5 UNITS: MG/15ML EPHEDRINE SULFATE STRENGTH: 18.75 UNITS: MG/15ML THEOPHYLLINE STRENGTH: 97.5 UNITS: MG/15ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2003-07-31 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	EPHEDRINE/HYDROXYZINE/THEOPHYLLINE 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	NO
PGX SUPPRESSED	NO
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4005063
EFFECTIVE DATE/TIME	2003-07-31 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE