PEDIASURE LIQUID CHOCOLATE (26119) VA PRODUCT (50.68)

Name	Value
NAME	PEDIASURE LIQUID CHOCOLATE
VA GENERIC NAME	PEDIASURE
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
ACTIVE INGREDIENTS	TAURINE STRENGTH: 17 UNITS: MG/240ML CHLORIDE STRENGTH: 240 UNITS: MG/240ML SAFFLOWER OIL VITAMIN K STRENGTH: 9 UNITS: MCG/240ML SUCROSE SODIUM CASEINATE RIBOFLAVIN STRENGTH: 0.5 UNITS: MG/240ML BIOTIN STRENGTH: 76 UNITS: MCG/240ML VITAMIN D STRENGTH: 120 UNITS: UNIT/240ML CALCIUM STRENGTH: 230 UNITS: MG/240ML IRON STRENGTH: 3.3 UNITS: MG/240ML ZINC STRENGTH: 2.8 UNITS: MG/240ML COPPER STRENGTH: 0.24 UNITS: MG/240ML VITAMIN E STRENGTH: 5.4 UNITS: UNIT/240ML IODINE STRENGTH: 23 UNITS: MCG/240ML MAGNESIUM STRENGTH: 47 UNITS: MG/240ML NIACIN STRENGTH: 4 UNITS: MG/240ML VITAMIN A PALMITATE STRENGTH: 610 UNITS: UNIT/240ML PANTOTHENIC ACID STRENGTH: 2.4 UNITS: MG/240ML CARRAGEENAN COCONUT OIL CORN STARCH,HYDROLYZED INOSITOL STRENGTH: 19 UNITS: MG/240ML PHOSPHORUS STRENGTH: 190 UNITS: MG/240ML POTASSIUM STRENGTH: 310 UNITS: MG/240ML MOLYBDENUM STRENGTH: 8.5 UNITS: MCG/240ML CHOLINE STRENGTH: 71 UNITS: MG/240ML MANGANESE STRENGTH: 0.59 UNITS: MG/240ML SELENIUM STRENGTH: 5.4 UNITS: MCG/240ML SOY LECITHIN CHROMIUM STRENGTH: 7.1 UNITS: MCG/240ML CYANOCOBALAMIN STRENGTH: 1.4 UNITS: MCG/240ML PHYTONADIONE THIAMINE HYDROCHLORIDE STRENGTH: 0.64 UNITS: MG/240ML ASCORBIC ACID STRENGTH: 24 UNITS: MG/240ML SODIUM STRENGTH: 90 UNITS: MG/240ML PYRIDOXINE HYDROCHLORIDE STRENGTH: 0.62 UNITS: MG/240ML FOLIC ACID STRENGTH: 88 UNITS: MCG/240ML
NATIONAL FORMULARY NAME	PEDIASURE 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	NUTRITION SUPL PEDIASURE/CHOCOLATE LIQ
VA PRODUCT IDENTIFIER	N0722
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	240ML BTL
MASTER ENTRY FOR VUID	YES
VUID	4034910
EFFECTIVE DATE/TIME	2015-10-23 00:00:00 STATUS: ACTIVE