DEXTROSE 1.87GM/LEVULOSE 1.87GM/PHOSPHORIC ACID 21.5MG/5ML SOLN (9673) VA PRODUCT (50.68)

Name	Value
NAME	DEXTROSE 1.87GM/LEVULOSE 1.87GM/PHOSPHORIC ACID 21.5MG/5ML SOLN
VA GENERIC NAME	DEXTROSE/LEVULOSE/PHOSPHORIC ACID
DOSAGE FORM	SOLN
ACTIVE INGREDIENTS	FRUCTOSE STRENGTH: 1.87 UNITS: GM/5ML PHOSPHORIC ACID STRENGTH: 21.5 UNITS: MG/5ML DEXTROSE STRENGTH: 1.87 UNITS: GM/5ML
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	1
NATIONAL FORMULARY NAME	DEXTROSE/LEVULOSE/PHOSPHORIC ACID SOLN
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	DEXTROSE/FRUCTOSE/PHOSPHORIC AC SOLN
VA PRODUCT IDENTIFIER	D0188
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4010082
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE