REPLETE FIBER LIQUID (26592) VA PRODUCT (50.68)

Name	Value
NAME	REPLETE FIBER LIQUID
VA GENERIC NAME	REPLETE
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
ACTIVE INGREDIENTS	WATER VITAMIN K MALTODEXTRIN NIACINAMIDE BIOTIN POTASSIUM IODIDE VITAMIN C VITAMIN A VITAMIN D MILK CALCIUM IRON ZINC COPPER VITAMIN E MAGNESIUM CANOLA OIL POTASSIUM CHOLINE SOY LECITHIN TRIGLYCERIDES,MEDIUM CHAIN CYANOCOBALAMIN BETA CAROTENE FIBER PHYTONADIONE VITAMIN B1 THIAMINE SODIUM FOLIC ACID
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	REPLETE 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 REPLETE FIBER LIQUID
VA PRODUCT IDENTIFIER	N0762
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	250ML CAN
MASTER ENTRY FOR VUID	YES
VUID	4035426
EFFECTIVE DATE/TIME	2016-02-19 00:00:00 STATUS: ACTIVE