PLASMA-LYTE 56/DEXTROSE 5% INJ (5457) VA PRODUCT (50.68)

Name	Value
NAME	PLASMA-LYTE 56/DEXTROSE 5% INJ
VA GENERIC NAME	DEXTROSE/ELECTROLYTES
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	POTASSIUM ACETATE STRENGTH: 128 UNITS: MG/100ML SODIUM CHLORIDE STRENGTH: 234 UNITS: MG/100ML DEXTROSE STRENGTH: 5 UNITS: GM/100ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	26
NATIONAL FORMULARY NAME	DEXTROSE/ELECTROLYTES INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 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	4005987
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE