IRON (POLYSACCHARIDE COMPLEX) 150MG/FA 1MG/B12 25MCG CAP (14203) VA PRODUCT (50.68)

Name	Value
NAME	IRON (POLYSACCHARIDE COMPLEX) 150MG/FA 1MG/B12 25MCG CAP
VA GENERIC NAME	IRON/MULTIVITAMINS
DOSAGE FORM	CAP,ORAL
ACTIVE INGREDIENTS	IRON (AS POLYSACCHARIDE COMPLEX) STRENGTH: 150 UNITS: MG CYANOCOBALAMIN STRENGTH: 25 UNITS: MCG FOLIC ACID STRENGTH: 1 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	IRON/MULTIVITAMINS CAP,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2018-06-14 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2018-06-15 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	IRON(POLYS) 150MG/FA 1MG/B12 25MCG CAP
VA PRODUCT IDENTIFIER	I0293
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CAP
MASTER ENTRY FOR VUID	YES
VUID	4014567
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE