PEG-3350/ELECTROLYTES PWDR (7812) VA PRODUCT (50.68)

Name	Value
NAME	PEG-3350/ELECTROLYTES PWDR
VA GENERIC NAME	ELECTROLYTES/PEG-3350
DOSAGE FORM	PWDR,RENST-ORAL
FDA MED GUIDE	PEG-3350_(Generic)_(2019).pdf
ACTIVE INGREDIENTS	SODIUM SULFATE STRENGTH: 22.74 UNITS: GM POLYETHYLENE GLYCOL 3350 STRENGTH: 236 UNITS: GM SODIUM CHLORIDE STRENGTH: 5.86 UNITS: GM POTASSIUM CHLORIDE STRENGTH: 2.97 UNITS: GM SODIUM BICARBONATE STRENGTH: 6.74 UNITS: GM
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	1
NATIONAL FORMULARY NAME	ELECTROLYTES/PEG-3350 PWDR,RENST-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	COLON ELECTROLYTE LAVAGE PWD FOR SOLN
VA PRODUCT IDENTIFIER	P0011
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4008290
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE