ULTRACAL TUBE-FEEDING LIQUID (12121) VA PRODUCT (50.68)

Name	Value
NAME	ULTRACAL TUBE-FEEDING LIQUID
VA GENERIC NAME	ULTRACAL
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
ACTIVE INGREDIENTS	POTASSIUM CITRATE CHROMIC CHLORIDE TAURINE MALTODEXTRIN CALCIUM CASEINATE SODIUM CASEINATE SOY OIL,PARTIALLY HYDROGENATED CALCIUM PANTOTHENATE NIACINAMIDE RIBOFLAVIN TOCOPHERYL ACETATE,DL-ALPHA BIOTIN POTASSIUM IODIDE CUPRIC SULFATE ZINC SULFATE FERROUS SULFATE CALCIUM PHOSPHATE POTASSIUM PHOSPHATE CHOLECALCIFEROL VITAMIN A PALMITATE CANOLA OIL CARRAGEENAN CHOLINE CHLORIDE DIGLYCERIDE MANGANESE SULFATE MONOGLYCERIDE SODIUM MOLYBDATE SOY FIBER SOY LECITHIN TRIGLYCERIDES,MEDIUM CHAIN CYANOCOBALAMIN OATS SODIUM SELENITE PHYTONADIONE THIAMINE HYDROCHLORIDE POTASSIUM CHLORIDE SODIUM CITRATE SODIUM ASCORBATE SODIUM PHOSPHATE PYRIDOXINE HYDROCHLORIDE MAGNESIUM CHLORIDE FOLIC ACID
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2009-08-12 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ULTRACAL 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 ULTRACAL/TUBE FEEDING
VA PRODUCT IDENTIFIER	N0202
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	240ML CAN
MASTER ENTRY FOR VUID	YES
VUID	4012487
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2009-08-12 00:00:00 STATUS: INACTIVE