ENSURE CLEAR LIQUID MIXED BERRY (26437) VA PRODUCT (50.68)

Name	Value
NAME	ENSURE CLEAR LIQUID MIXED BERRY
VA GENERIC NAME	ENSURE
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
FORMULARY DESIGNATOR TEXT	Restricted to Fat-restricted, Fat-malabsorptive, or Clear-liquid Diets
ACTIVE INGREDIENTS	VITAMIN K RIBOFLAVIN BIOTIN VITAMIN C VITAMIN A VITAMIN D CALCIUM IRON ZINC COPPER VITAMIN E IODINE NIACIN PANTOTHENIC ACID MOLYBDENUM MANGANESE SELENIUM CHROMIUM CYANOCOBALAMIN PHYTONADIONE VITAMIN B6 THIAMINE FOLIC ACID
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	ENSURE 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 ENSURE CLEAR LIQ/M BERRY
VA PRODUCT IDENTIFIER	N0815
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	CAN
MASTER ENTRY FOR VUID	YES
VUID	4035257
EFFECTIVE DATE/TIME	2015-12-29 00:00:00 STATUS: ACTIVE