| NAME |
HYDROCODONE POLISTIREX 10MG/CHLORPHENIRAMINE 8MG/5ML SUSP,SA |
| VA GENERIC NAME |
CHLORPHENIRAMINE/HYDROCODONE |
| DOSAGE FORM |
SUSP,SA |
| FDA MED GUIDE |
Hydrocodone_Chlorpheniramine_SA_Susp_(Generic)_(2017).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Schedule II |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
CHLORPHENIRAMINE/HYDROCODONE SUSP,SA |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
YES |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
HYDROCODONE 10/CHLORPHEN 8MG/5ML SA SUSP |
| VA PRODUCT IDENTIFIER |
H0613 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008661 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
