| NAME |
FECAL MICROBIOTA LIVE-JSLM RTL,BAG,150ML |
| VA GENERIC NAME |
FECAL MICROBIOTA-JSLM |
| DOSAGE FORM |
SUSP,RTL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY NAME |
FECAL MICROBIOTA-JSLM SUSP,RTL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2022-12-22 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
FECAL MICROBIOTA LIVE-JSLM RTL BAG 150ML |
| VA PRODUCT IDENTIFIER |
F0740 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
BAG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041914 |
| EFFECTIVE DATE/TIME |
-
- 2022-12-22 00:00:00
- STATUS: ACTIVE
|
