CODEINE 30MG/ASA 325MG/BUTALBITAL 50MG/CAFN 40MG CAP (5920) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE 30MG/ASA 325MG/BUTALBITAL 50MG/CAFN 40MG CAP
VA GENERIC NAME	ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE
DOSAGE FORM	CAP,ORAL
FDA MED GUIDE	Codeine-ASA-Butalbital-Caffeine_(Generic)_(2019).pdf
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	ASPIRIN STRENGTH: 325 UNITS: MG CAFFEINE STRENGTH: 40 UNITS: MG CODEINE PHOSPHATE STRENGTH: 30 UNITS: MG BUTALBITAL STRENGTH: 50 UNITS: MG
CS FEDERAL SCHEDULE	Schedule III
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	2
NATIONAL FORMULARY NAME	ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE CAP,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2019-04-22 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2019-04-23 00:00:00
PGX ELIGIBLE	YES
PGX SUPPRESSED	YES
VA PRINT NAME	CODEINE 30/ASA 325/BUTALB 50MG/CAFN CAP
VA PRODUCT IDENTIFIER	C0933
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4006443
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE