JEVITY LIQUID TUBE FEEDING (11722) VA PRODUCT (50.68)

Name	Value
NAME	JEVITY LIQUID TUBE FEEDING
VA GENERIC NAME	JEVITY
DOSAGE FORM	LIQUID
ACTIVE INGREDIENTS	TAURINE STRENGTH: 27 UNITS: MG/240ML CHLORIDE STRENGTH: 310 UNITS: MG/240ML VITAMIN K STRENGTH: 15 UNITS: MCG/240ML CALCIUM CASEINATE SODIUM CASEINATE RIBOFLAVIN STRENGTH: 0.46 UNITS: MG/240ML BIOTIN STRENGTH: 81 UNITS: MCG/240ML VITAMIN D STRENGTH: 72 UNITS: UNIT/240ML CALCIUM STRENGTH: 215 UNITS: MG/240ML IRON STRENGTH: 3.22 UNITS: MG/240ML ZINC STRENGTH: 4.02 UNITS: MG/240ML COPPER STRENGTH: 0.36 UNITS: MG/240ML IODINE STRENGTH: 26.8 UNITS: MCG/240ML MAGNESIUM STRENGTH: 71.5 UNITS: MG/240ML VITAMIN A PALMITATE STRENGTH: 893 UNITS: UNIT/240ML PANTOTHENIC ACID STRENGTH: 2.68 UNITS: MG/240ML CALCIUM PHOSPHATE,TRIBASIC COCONUT OIL CORN OIL CORN STARCH,HYDROLYZED PHOSPHORUS STRENGTH: 179 UNITS: MG/240ML POTASSIUM STRENGTH: 370 UNITS: MG/240ML MOLYBDENUM STRENGTH: 27 UNITS: MCG/240ML CHOLINE STRENGTH: 107 UNITS: MG/240ML MANGANESE STRENGTH: 0.89 UNITS: MG/240ML SELENIUM STRENGTH: 13 UNITS: MCG/240ML SOY FIBER SOY LECITHIN CHROMIUM STRENGTH: 18 UNITS: MCG/240ML CYANOCOBALAMIN STRENGTH: 1.7 UNITS: MCG/240ML THIAMINE HYDROCHLORIDE STRENGTH: 0.41 UNITS: MG/240ML ASCORBIC ACID STRENGTH: 53.6 UNITS: MG/240ML SODIUM STRENGTH: 220 UNITS: MG/240ML PYRIDOXINE HYDROCHLORIDE STRENGTH: 0.54 UNITS: MG/240ML FOLIC ACID STRENGTH: 108 UNITS: MCG/240ML
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-05-06 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	JEVITY LIQUID
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	NUTRITION SUPL JEVITY/TUBE FEEDING LIQ
VA PRODUCT IDENTIFIER	J0001
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	240ML CAN
MASTER ENTRY FOR VUID	YES
VUID	4012093
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-05-06 00:00:00 STATUS: INACTIVE