DIPHENHYDRAMINE 12.5MG/GG 100MG/MENTHOL 1MG/NA CIT 50MG/5ML LIQ (7470) VA PRODUCT (50.68)

Name	Value
NAME	DIPHENHYDRAMINE 12.5MG/GG 100MG/MENTHOL 1MG/NA CIT 50MG/5ML LIQ
VA GENERIC NAME	DIPHENHYDRAMINE/GUAIFENESIN/MENTHOL/SODIUM CITRATE
DOSAGE FORM	LIQUID,ORAL
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 1 UNITS: MG/5ML DIPHENHYDRAMINE HYDROCHLORIDE STRENGTH: 12.5 UNITS: MG/5ML SODIUM CITRATE STRENGTH: 50 UNITS: MG/5ML GUAIFENESIN STRENGTH: 100 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-28 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	DIPHENHYDRAMINE/GUAIFENESIN/MENTHOL/SODIUM CITRATE LIQUID,ORAL
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	4007974
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-28 00:00:00 STATUS: INACTIVE