TRACE-4 MULTIPLE TRACE ELEMENTS INJ (6871) VA PRODUCT (50.68)

Name	Value
NAME	TRACE-4 MULTIPLE TRACE ELEMENTS INJ
VA GENERIC NAME	CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/ZINC SULFATE
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	CHROMIC CHLORIDE STRENGTH: 0.05 UNITS: MG CUPRIC SULFATE STRENGTH: 3.9 UNITS: MG ZINC SULFATE STRENGTH: 17.4 UNITS: MG MANGANESE SULFATE STRENGTH: 1.52 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2014-01-17 00:00:00
DSS NUMBER	9
NATIONAL FORMULARY NAME	CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/ZINC SULFATE INJ,SOLN
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 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	4007384
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE