DELFLEX/DEXTROSE 4.25% SOLN (5639) VA PRODUCT (50.68)

Name	Value
NAME	DELFLEX/DEXTROSE 4.25% SOLN
VA GENERIC NAME	DEXTROSE/PERITONEAL DIALYSIS SOLUTION
DOSAGE FORM	SOLN,DIALYSIS
ACTIVE INGREDIENTS	SODIUM LACTATE STRENGTH: 392 UNITS: MG/100ML SODIUM CHLORIDE STRENGTH: 567 UNITS: MG/100ML DEXTROSE STRENGTH: 4.25 UNITS: GM/100ML CALCIUM CHLORIDE STRENGTH: 25.7 UNITS: MG/100ML MAGNESIUM CHLORIDE STRENGTH: 15.2 UNITS: MG/100ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	37
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	4006164
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE