NEPRO CARB STEADY LIQUID VANILLA (18088) VA PRODUCT (50.68)

Name	Value
NAME	NEPRO CARB STEADY LIQUID VANILLA
VA GENERIC NAME	NEPRO
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to Nephrology
ACTIVE INGREDIENTS	TAURINE CHLORIDE SAFFLOWER OIL VITAMIN K SUCROSE CALCIUM CASEINATE SODIUM CASEINATE CORN SYRUP CALCIUM HYDROXIDE RIBOFLAVIN BIOTIN VITAMIN A VITAMIN D CALCIUM IRON ZINC COPPER IODINE PYRIDOXINE MAGNESIUM PANTOTHENIC ACID PHOSPHORUS POTASSIUM CHOLINE MANGANESE SELENIUM SOY LECITHIN CYANOCOBALAMIN PHYTONADIONE ASCORBIC ACID THIAMINE SODIUM FOLIC ACID
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	NEPRO LIQUID,NUTRITIONAL SUPPLEMENT
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	NUTR SUPL NEPRO CARB STDY LIQ VANILLA
VA PRODUCT IDENTIFIER	N0636
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	240ML CAN
MASTER ENTRY FOR VUID	YES
VUID	4025819
EFFECTIVE DATE/TIME	2007-01-25 00:00:00 STATUS: ACTIVE