PEDTE-PAK-4 (6876) VA PRODUCT (50.68)

Name	Value
NAME	PEDTE-PAK-4
VA GENERIC NAME	CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/ZINC SULFATE
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	CHROMIC CHLORIDE STRENGTH: 1 UNITS: MCG/ML CUPRIC SULFATE STRENGTH: 0.1 UNITS: MG/ML ZINC SULFATE STRENGTH: 1 UNITS: MG/ML MANGANESE SULFATE STRENGTH: 0.025 UNITS: MG/ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2008-09-02 00:00:00
DSS NUMBER	14
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: 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	4007389
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2008-09-02 00:00:00 STATUS: INACTIVE