DEXTROMETHORPHAN 15MG/GUAIFENESIN 300MG SPRINKLE CAP,SA (4931) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROMETHORPHAN 15MG/GUAIFENESIN 300MG SPRINKLE CAP,SA
VA GENERIC NAME	DEXTROMETHORPHAN/GUAIFENESIN
DOSAGE FORM	CAP,SPRINKLE,SA
ACTIVE INGREDIENTS	DEXTROMETHORPHAN HYDROBROMIDE STRENGTH: 15 UNITS: MG GUAIFENESIN STRENGTH: 300 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2009-11-17 00:00:00
DSS NUMBER	18
NATIONAL FORMULARY NAME	DEXTROMETHORPHAN/GUAIFENESIN CAP,SPRINKLE,SA
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 300MG SA SPRINKLE CAP
VA PRODUCT IDENTIFIER	D0334
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4005472
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2009-11-17 00:00:00 STATUS: INACTIVE