POLY-HISTINE-D PEDIATRIC CAP,SA (6414) VA PRODUCT (50.68)

Name	Value
NAME	POLY-HISTINE-D PEDIATRIC CAP,SA
VA GENERIC NAME	PHENIRAMINE/PHENYLPROPANOLAMINE/PHENYLTOLOXAMINE/PYRILAMINE
DOSAGE FORM	CAP,SA
ACTIVE INGREDIENTS	PHENIRAMINE MALEATE STRENGTH: 8 UNITS: MG PHENYLPROPANOLAMINE HYDROCHLORIDE STRENGTH: 25 UNITS: MG PHENYLTOLOXAMINE DIHYDROGEN CITRATE STRENGTH: 8 UNITS: MG PYRILAMINE MALEATE STRENGTH: 8 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2005-10-14 00:00:00
DSS NUMBER	3
NATIONAL FORMULARY NAME	PHENIRAMINE/PHENYLPROPANOLAMINE/PHENYLTOLOXAMINE/PYRILAMINE CAP,SA
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	4006934
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-10-14 00:00:00 STATUS: INACTIVE