DIPHENHYDRAMINE 12.5MG/PSEUDOEPHEDRINE 60MG/5ML SYRUP (9286) VA PRODUCT (50.68)

Name	Value
NAME	DIPHENHYDRAMINE 12.5MG/PSEUDOEPHEDRINE 60MG/5ML SYRUP
VA GENERIC NAME	DIPHENHYDRAMINE/PSEUDOEPHEDRINE
DOSAGE FORM	SYRUP
ACTIVE INGREDIENTS	MENTHOL ALCOHOL STRENGTH: 5 UNITS: % SACCHARIN SODIUM WATER,PURIFIED SUCROSE F D & C YELLOW #6 GLUCOSE LIQUID DIPHENHYDRAMINE HYDROCHLORIDE STRENGTH: 12.5 UNITS: MG/5ML SODIUM CITRATE PSEUDOEPHEDRINE HYDROCHLORIDE STRENGTH: 30 UNITS: MG/5ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-19 00:00:00
DSS NUMBER	3
NATIONAL FORMULARY NAME	DIPHENHYDRAMINE/PSEUDOEPHEDRINE SYRUP
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	DIPHENHYDRAMINE 12.5/PSEUDO 60MG/5ML SYR
VA PRODUCT IDENTIFIER	D0261
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009712
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-19 00:00:00 STATUS: INACTIVE