PYRADEINE W/ANTIHISTAMINE & CODEINE SYRUP (7213) VA PRODUCT (50.68)

Name	Value
NAME	PYRADEINE W/ANTIHISTAMINE & CODEINE SYRUP
VA GENERIC NAME	AMMONIUM/ANTIMONY/CODEINE/PHENYLEPHRINE/POTASSIUM/PYRILAMINE
DOSAGE FORM	SYRUP
ACTIVE INGREDIENTS	AMMONIUM CHLORIDE STRENGTH: 86 UNITS: MG POTASSIUM GUAIACOLSULFONATE STRENGTH: 86 UNITS: MG ANTIMONY POTASSIUM TARTRATE STRENGTH: 0.9 UNITS: MG PHENYLEPHRINE HYDROCHLORIDE STRENGTH: 5 UNITS: MG CODEINE PHOSPHATE STRENGTH: 10 UNITS: MG PYRILAMINE MALEATE STRENGTH: 8.3 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-10-01 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMMONIUM/ANTIMONY/CODEINE/PHENYLEPHRINE/POTASSIUM/PYRILAMINE SYRUP
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	4007721
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-10-01 00:00:00 STATUS: INACTIVE