SUSTACAL W/FIBER LIQUID VANILLA (12122) VA PRODUCT (50.68)

Name	Value
NAME	SUSTACAL W/FIBER LIQUID VANILLA
VA GENERIC NAME	SUSTACAL W/FIBER
DOSAGE FORM	LIQUID
ACTIVE INGREDIENTS	MALTODEXTRIN CALCIUM CASEINATE SODIUM CASEINATE SOY PROTEIN ISOLATE NIACINAMIDE RIBOFLAVIN TOCOPHERYL ACETATE,DL-ALPHA CHOLECALCIFEROL VITAMIN A PALMITATE CARRAGEENAN CORN OIL DIGLYCERIDE MONOGLYCERIDE SOY FIBER SOY LECITHIN SUGAR SODIUM CHLORIDE THIAMINE HYDROCHLORIDE SODIUM ASCORBATE PYRIDOXINE HYDROCHLORIDE FOLIC ACID
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	1999-06-07 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	SUSTACAL W/FIBER 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 SUSTACAL W/FIBER/VAN LIQ
VA PRODUCT IDENTIFIER	N0203
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	240ML CAN
MASTER ENTRY FOR VUID	YES
VUID	4012488
EFFECTIVE DATE/TIME	1999-06-07 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE