DIANEAL PD-2/DEXTROSE 1.5% SOLN (5633) VA PRODUCT (50.68)

Name	Value
NAME	DIANEAL PD-2/DEXTROSE 1.5% SOLN
VA GENERIC NAME	DEXTROSE/PERITONEAL DIALYSIS SOLUTION
DOSAGE FORM	SOLN,DIALYSIS
ACTIVE INGREDIENTS	SODIUM LACTATE STRENGTH: 448 UNITS: MG/100ML SODIUM CHLORIDE STRENGTH: 538 UNITS: MG/100ML DEXTROSE STRENGTH: 1.5 UNITS: GM/100ML CALCIUM CHLORIDE STRENGTH: 25.7 UNITS: MG/100ML MAGNESIUM CHLORIDE STRENGTH: 5.08 UNITS: MG/100ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	31
NATIONAL FORMULARY NAME	DEXTROSE/PERITONEAL DIALYSIS SOLUTION 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	4006158
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE