| NAME |
PKU COOLER 15 LIQUID |
| VA GENERIC NAME |
PKU COOLER |
| DOSAGE FORM |
LIQUID,NUTRITIONAL SUPPLEMENT |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
NUTRITION SUPL PKU COOLER LIQUID,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 PKU COOLER 15 LIQUID |
| VA PRODUCT IDENTIFIER |
N0690 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033695 |
| EFFECTIVE DATE/TIME |
-
- 2014-09-23 00:00:00
- STATUS: ACTIVE
|
