SYRUP #1 (MIKART) LIQUID (7614) VA PRODUCT (50.68)

Name	Value
NAME	SYRUP #1 (MIKART) LIQUID
VA GENERIC NAME	CHLORPHENIRAMINE/HYDROCODONE/NH4/PHENINDAMINE/PHENYLEPHRINE/PYRI
DOSAGE FORM	LIQUID,ORAL
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	ALCOHOL,DEHYDRATED STRENGTH: 5 UNITS: % HYDROCODONE BITARTRATE STRENGTH: 2.5 UNITS: MG AMMONIUM CHLORIDE STRENGTH: 50 UNITS: MG PHENINDAMINE TARTRATE STRENGTH: 5 UNITS: MG PHENYLEPHRINE HYDROCHLORIDE STRENGTH: 5 UNITS: MG CHLORPHENIRAMINE MALEATE STRENGTH: 2 UNITS: MG PYRILAMINE MALEATE STRENGTH: 6 UNITS: MG
CS FEDERAL SCHEDULE	Schedule II
INACTIVATION DATE	2007-10-01 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	CHLORPHENIRAMINE/HYDROCODONE/NH4/PHENINDAMINE/PHENYLEPHRINE/PYRI 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	4008110
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-10-01 00:00:00 STATUS: INACTIVE