EPHEDRINE 12MG/GG 78MG/PHENOBARB 7.5MG/THEOPHYLLINE 60MG/15ML EL (6258) VA PRODUCT (50.68)

Name	Value
NAME	EPHEDRINE 12MG/GG 78MG/PHENOBARB 7.5MG/THEOPHYLLINE 60MG/15ML EL
VA GENERIC NAME	EPHEDRINE/GUAIFENESIN/PHENOBARBITAL/THEOPHYLLINE
DOSAGE FORM	ELIXIR
ACTIVE INGREDIENTS	EPHEDRINE HYDROCHLORIDE STRENGTH: 12 UNITS: MG/15ML PHENOBARBITAL STRENGTH: 7.5 UNITS: MG/15ML ALCOHOL STRENGTH: 20 UNITS: % THEOPHYLLINE STRENGTH: 60 UNITS: MG/15ML GUAIFENESIN STRENGTH: 78 UNITS: MG/15ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2003-07-31 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	EPHEDRINE/GUAIFENESIN/PHENOBARBITAL/THEOPHYLLINE ELIXIR
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4006778
EFFECTIVE DATE/TIME	2003-07-31 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE