PROSOURCE GELATEIN PLUS LIME W/MCT GEL,ORAL (30052) VA PRODUCT (50.68)

Name	Value
NAME	PROSOURCE GELATEIN PLUS LIME W/MCT GEL,ORAL
VA GENERIC NAME	PROSOURCE PLUS
DOSAGE FORM	GEL,ORAL
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	HISTIDINE ISOLEUCINE METHIONINE THREONINE TRYPTOPHAN LEUCINE TRIGLYCERIDES,MEDIUM CHAIN
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	PROSOURCE PLUS GEL,ORAL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2020-04-08 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	NUTR SUPL PROSOURCE GEL PLUS W/MCT LIME
VA PRODUCT IDENTIFIER	N0846
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4039291
EFFECTIVE DATE/TIME	2020-04-08 00:00:00 STATUS: ACTIVE