DIALYSATE,PRISMASATE BKG4/0/1.2 SOLN (31054) VA PRODUCT (50.68)

Name	Value
NAME	DIALYSATE,PRISMASATE BKG4/0/1.2 SOLN
VA GENERIC NAME	PRISMASATE
DOSAGE FORM	SOLN,DIALYSIS
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CHLORIDE GLUCOSE CALCIUM MAGNESIUM LACTATE POTASSIUM BICARBONATE SODIUM
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2022-01-06 00:00:00
NATIONAL FORMULARY NAME	PRISMASATE SOLN,DIALYSIS
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2021-04-28 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	DIALYSATE,PRISMASATE BKG4/0/1.2 SOLN
VA PRODUCT IDENTIFIER	D1261
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	BAG
MASTER ENTRY FOR VUID	YES
VUID	4040401
EFFECTIVE DATE/TIME	2021-04-29 00:00:00 STATUS: ACTIVE 2021-04-29 00:00:00 STATUS: ACTIVE 2021-04-29 00:00:00 STATUS: ACTIVE 2022-01-06 00:00:00 STATUS: INACTIVE