| NAME |
FIBER,NUTRISOURCE POWDER,ORAL,PACKET,4GM |
| VA GENERIC NAME |
FIBER |
| DOSAGE FORM |
POWDER,ORAL |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
FIBER POWDER,ORAL |
| 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 |
FIBER,NUTRISOURCE ORAL POWDER 4GM PKT |
| VA PRODUCT IDENTIFIER |
F0597 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035529 |
| EFFECTIVE DATE/TIME |
-
- 2016-03-22 00:00:00
- STATUS: ACTIVE
|
