CODEINE POLISTIREX 10MG/CHLORPHENIRAMINE 4MG/5ML SUSP,SA (8585) VA PRODUCT (50.68)

Name	Value
NAME	CODEINE POLISTIREX 10MG/CHLORPHENIRAMINE 4MG/5ML SUSP,SA
VA GENERIC NAME	CHLORPHENIRAMINE/CODEINE
DOSAGE FORM	SUSP,SA
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CHLORPHENIRAMINE POLISTIREX STRENGTH: 4 UNITS: MG/5ML CODEINE POLISTIREX STRENGTH: 10 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Schedule V
INACTIVATION DATE	2007-09-19 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	CHLORPHENIRAMINE/CODEINE SUSP,SA
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	CODEINE POLISTIRX 10/CTM 4MG/5ML SA SUSP
VA PRODUCT IDENTIFIER	C0905
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009045
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-19 00:00:00 STATUS: INACTIVE