MYCELIA EXTRACT (16981)    VA PRODUCT (50.68)

Name Value
NAME MYCELIA EXTRACT
VA GENERIC NAME MYCELIA EXTRACT
DOSAGE FORM NUTRACEUTICAL
ACTIVE INGREDIENTS
NATIONAL FORMULARY NAME MYCELIA EXTRACT NUTRACEUTICAL
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME MYCELIA EXTRACT
VA PRODUCT IDENTIFIER M0633
TRANSMIT TO CMOP NO
VA DISPENSE UNIT GM
MASTER ENTRY FOR VUID YES
VUID 4017344
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE