HYDROCODONE 2.5MG/CTM 2MG/MENTHOL/PSEUDEFED 30MG/5ML SYRUP (7617) VA PRODUCT (50.68)

Name	Value
NAME	HYDROCODONE 2.5MG/CTM 2MG/MENTHOL/PSEUDEFED 30MG/5ML SYRUP
VA GENERIC NAME	CHLORPHENIRAMINE/HYDROCODONE/MENTHOL/PSEUDOEPHEDRINE
DOSAGE FORM	LIQUID,ORAL
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	HYDROCODONE BITARTRATE STRENGTH: 2.5 UNITS: MG/5ML MENTHOL CHLORPHENIRAMINE MALEATE STRENGTH: 2 UNITS: MG/5ML PSEUDOEPHEDRINE HYDROCHLORIDE STRENGTH: 30 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Schedule II
INACTIVATION DATE	2007-09-28 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	CHLORPHENIRAMINE/HYDROCODONE/MENTHOL/PSEUDOEPHEDRINE 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
VA PRINT NAME	HYDROCODONE 2.5/CTM 2/PSEUDO 30MG/5ML LI
VA PRODUCT IDENTIFIER	H0317
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4008113
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-28 00:00:00 STATUS: INACTIVE