M-TRACE 5 INJ,CONC (7033) VA PRODUCT (50.68)

Name	Value
NAME	M-TRACE 5 INJ,CONC
VA GENERIC NAME	CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/SELENIUM/ZINC
DOSAGE FORM	INJ,SOLN
ACTIVE INGREDIENTS	CHROMIC CHLORIDE STRENGTH: 10 UNITS: MCG/ML CUPRIC SULFATE STRENGTH: 1 UNITS: MG/ML ZINC SULFATE STRENGTH: 5 UNITS: MG/ML MANGANESE SULFATE STRENGTH: 0.5 UNITS: MG/ML SELENIOUS ACID STRENGTH: 60 UNITS: MCG/ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2014-01-17 00:00:00
DSS NUMBER	7
NATIONAL FORMULARY NAME	CHROMIC CHLORIDE/CUPRIC SULFATE/MANGANESE SULFATE/SELENIUM/ZINC 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
VA PRINT NAME	M-TRACE 5 INJ,CONC
VA PRODUCT IDENTIFIER	M0728
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4007543
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE