GLUCERNA THERAPEUTIC NUTRITION SHAKE LIQUID CHOCOLATE (29929) VA PRODUCT (50.68)

Name	Value
NAME	GLUCERNA THERAPEUTIC NUTRITION SHAKE LIQUID CHOCOLATE
VA GENERIC NAME	GLUCERNA
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
HAZARDOUS TO DISPOSE	NO
FORMULARY DESIGNATOR	PA-F
FORMULARY DESIGNATOR TEXT	Restricted to DM
ACTIVE INGREDIENTS	VITAMIN K RIBOFLAVIN BIOTIN VITAMIN A VITAMIN D VITAMIN E PYRIDOXINE NIACIN PANTOTHENIC ACID CHOLINE CYANOCOBALAMIN PHYTONADIONE ASCORBIC ACID THIAMINE FOLIC ACID
NATIONAL FORMULARY INDICATOR	YES
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	GLUCERNA LIQUID,NUTRITIONAL SUPPLEMENT
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2020-02-12 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	NUTR SUPL GLUCERNA THER NUTR SHAKE CHOC
VA PRODUCT IDENTIFIER	N0839
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	240ML BTL
MASTER ENTRY FOR VUID	YES
VUID	4039156
EFFECTIVE DATE/TIME	2020-02-14 00:00:00 STATUS: ACTIVE