ISOLATE COMPOUND ELIXIR (6576) VA PRODUCT (50.68)

Name	Value
NAME	ISOLATE COMPOUND ELIXIR
VA GENERIC NAME	ISOLATE
DOSAGE FORM	ELIXIR
ACTIVE INGREDIENTS	PHENOBARBITAL STRENGTH: 6 UNITS: MG/15ML ALCOHOL STRENGTH: 19 UNITS: % POTASSIUM IODIDE STRENGTH: 150 UNITS: MG/15ML EPHEDRINE SULFATE STRENGTH: 12 UNITS: MG/15ML THEOPHYLLINE STRENGTH: 45 UNITS: MG/15ML ISOPROTERENOL HYDROCHLORIDE STRENGTH: 2.5 UNITS: MG/15ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2002-04-04 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ISOLATE 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
VA PRINT NAME	ISOLATE COMPOUND ELIXIR
VA PRODUCT IDENTIFIER	I0124
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	NO
VUID	4007092
EFFECTIVE DATE/TIME	2002-04-04 00:00:00 STATUS: INACTIVE 2005-12-06 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE