DEXTROMETHORPHAN 15MG/GUAIFENESIN 200MG/5ML LIQUID (4919) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROMETHORPHAN 15MG/GUAIFENESIN 200MG/5ML LIQUID
VA GENERIC NAME	DEXTROMETHORPHAN/GUAIFENESIN
DOSAGE FORM	LIQUID
ACTIVE INGREDIENTS	DEXTROMETHORPHAN HYDROBROMIDE STRENGTH: 15 UNITS: MG/5ML GUAIFENESIN STRENGTH: 200 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	5
NATIONAL FORMULARY NAME	DEXTROMETHORPHAN/GUAIFENESIN LIQUID
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
VA PRINT NAME	DM 15/GUAIFENESIN 200MG/5ML LIQUID
VA PRODUCT IDENTIFIER	D0184
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4005460
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE