| NAME |
MAITAKE MUSHROOM EXTRACT CAP/TAB |
| VA GENERIC NAME |
MAITAKE MUSHROOM |
| DOSAGE FORM |
CAP/TAB |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY NAME |
MAITAKE MUSHROOM CAP/TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
MAITAKE MUSHROOM EXTRACT CAP/TAB |
| VA PRODUCT IDENTIFIER |
M1044 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
CAP/TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034062 |
| EFFECTIVE DATE/TIME |
-
- 2015-01-15 00:00:00
- STATUS: ACTIVE
|
