CODEINE 10MG/AMMONIUM CL 40MG/CTM 4MG/P-EPHRINE 10MG/5ML ELIXIR (7668) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE 10MG/AMMONIUM CL 40MG/CTM 4MG/P-EPHRINE 10MG/5ML ELIXIR
VA GENERIC NAME	AMMONIUM CHLORIDE/CHLORPHENIRAMINE/CODEINE/PHENYLEPHRINE
DOSAGE FORM	ELIXIR
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	AMMONIUM CHLORIDE STRENGTH: 40 UNITS: MG/5ML PHENYLEPHRINE HYDROCHLORIDE STRENGTH: 10 UNITS: MG/5ML CHLORPHENIRAMINE MALEATE STRENGTH: 4 UNITS: MG/5ML CODEINE PHOSPHATE STRENGTH: 10 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Schedule V
INACTIVATION DATE	2007-09-19 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMMONIUM CHLORIDE/CHLORPHENIRAMINE/CODEINE/PHENYLEPHRINE ELIXIR
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	CODEIN 10/AM-CL 40/CPM 4/P-EPH 10MG/5ML
VA PRODUCT IDENTIFIER	C0775
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4008164
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-19 00:00:00 STATUS: INACTIVE