EPHEDRINE 36MG/GG 150MG/PHENOBARB 12MG/THEOPHYLLINE 45MG/15ML EL (6261) VA PRODUCT (50.68)

Name	Value
NAME	EPHEDRINE 36MG/GG 150MG/PHENOBARB 12MG/THEOPHYLLINE 45MG/15ML EL
VA GENERIC NAME	EPHEDRINE/GUAIFENESIN/PHENOBARBITAL/THEOPHYLLINE
DOSAGE FORM	ELIXIR
ACTIVE INGREDIENTS	PHENOBARBITAL STRENGTH: 12 UNITS: MG/15ML ALCOHOL STRENGTH: 19 UNITS: % EPHEDRINE SULFATE STRENGTH: 36 UNITS: MG/15ML SACCHARIN THEOPHYLLINE STRENGTH: 45 UNITS: MG/15ML GUAIFENESIN STRENGTH: 150 UNITS: MG/15ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2003-07-31 00:00:00
DSS NUMBER	4
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	4006781
EFFECTIVE DATE/TIME	2003-07-31 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE