| NAME |
4-MIXED TRACE ELEMENTS INJ |
| VA GENERIC NAME |
CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/ZINC SULFATE |
| DOSAGE FORM |
INJ |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.4 |
| INACTIVATION DATE |
2005-11-01 00:00:00 |
| UNITS |
MG |
| DSS NUMBER |
3 |
| NATIONAL FORMULARY NAME |
CHROMIC CHLORIDE/CUPRIC CHLORIDE/MANGANESE CHLORIDE/ZINC CHLORIDE INJ |
| 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 |
| VA PRINT NAME |
4-MIXED TRACE ELEMENTS INJ |
| VA PRODUCT IDENTIFIER |
40001 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4005129 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2005-11-01 00:00:00
- STATUS: INACTIVE
|
