| NAME |
PHENYLADE GPM ULTRA POWDER PACKET,33.4GM |
| VA GENERIC NAME |
PHENYLADE |
| DOSAGE FORM |
PWDR,RENST-ORAL |
| HAZARDOUS TO DISPOSE |
NO |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
PHENYLADE PWDR,RENST-ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2021-12-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
NUTR SUP PHENYLADE GPM ULTRA PKT 33.4GM |
| VA PRODUCT IDENTIFIER |
N0880 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4040997 |
| EFFECTIVE DATE/TIME |
-
- 2021-12-01 00:00:00
- STATUS: ACTIVE
|
