TRACE METALS ADDITIVE INJ (5599) VA PRODUCT (50.68)

Name	Value
NAME	TRACE METALS ADDITIVE INJ
VA GENERIC NAME	CHLORIDE/CHROMIUM/COPPER/MANGANESE/SODIUM/ZINC
DOSAGE FORM	INJ,CONC-SOLN
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CHROMIC CHLORIDE STRENGTH: 6 UNITS: MCG ZINC CHLORIDE STRENGTH: 1.67 UNITS: MG CUPRIC CHLORIDE STRENGTH: 0.42 UNITS: MG MANGANESE CHLORIDE STRENGTH: 0.37 UNITS: MG SODIUM CHLORIDE STRENGTH: 9 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2014-01-17 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	CHLORIDE/CHROMIUM/COPPER/MANGANESE/SODIUM/ZINC INJ,CONC-SOLN
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	TRACE METALS ADDITIVE INJ
VA PRODUCT IDENTIFIER	T0438
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4005128
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE