VIVONEX PEDIATRIC POWDER,PKT,51GM (12514) VA PRODUCT (50.68)

Name	Value
NAME	VIVONEX PEDIATRIC POWDER,PKT,51GM
VA GENERIC NAME	VIVONEX
DOSAGE FORM	PWDR,RENST-ORAL
ACTIVE INGREDIENTS	RIBOFLAVIN STRENGTH: 1.8 UNITS: MG/L VITAMIN C STRENGTH: 100 UNITS: MG/L VITAMIN A STRENGTH: 2500 UNITS: UNIT/L VITAMIN D STRENGTH: 500 UNITS: UNIT/L CALCIUM STRENGTH: 970 UNITS: MG/L IRON STRENGTH: 10 UNITS: MG/L ZINC STRENGTH: 12 UNITS: MG/L VITAMIN E STRENGTH: 30 UNITS: UNIT/L IODINE STRENGTH: 120 UNITS: MCG/L MAGNESIUM STRENGTH: 200 UNITS: MG/L NIACIN STRENGTH: 20 UNITS: MG/L PHOSPHORUS STRENGTH: 800 UNITS: MG/L POTASSIUM STRENGTH: 1200 UNITS: MG/L CYANOCOBALAMIN STRENGTH: 3 UNITS: MCG/L FAT STRENGTH: 24 UNITS: GM/L PROTEIN STRENGTH: 24 UNITS: GM/L VITAMIN B6 STRENGTH: 2 UNITS: MG/L THIAMINE STRENGTH: 1.5 UNITS: MG/L SODIUM STRENGTH: 400 UNITS: MG/L FOLIC ACID STRENGTH: 200 UNITS: MCG/L
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	7
NATIONAL FORMULARY NAME	VIVONEX PWDR,RENST-ORAL
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 VIVONEX/PEDIATRIC PWD
VA PRODUCT IDENTIFIER	N0303
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PKT
MASTER ENTRY FOR VUID	YES
VUID	4012880
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE