FIBERSOURCE HN LIQUID (9493) VA PRODUCT (50.68)

Name	Value
NAME	FIBERSOURCE HN LIQUID
VA GENERIC NAME	FIBERSOURCE
DOSAGE FORM	LIQUID,NUTRITIONAL SUPPLEMENT
HAZARDOUS TO DISPOSE	NO
DOT SHIPPING CODE
ACTIVE INGREDIENTS	POTASSIUM CITRATE CALCIUM CASEINATE SODIUM CASEINATE ZINC SULFATE FERROUS SULFATE POTASSIUM PHOSPHATE CALCIUM PHOSPHATE,TRIBASIC CANOLA OIL CHOLINE CHLORIDE CORN STARCH,HYDROLYZED FLAVOR,ARTIFICIAL HIGH CHROMIUM YEAST HIGH SELENIUM YEAST POLYGLYCEROL ESTERS OF FATTY ACIDS SOY FIBER TRIGLYCERIDES,MEDIUM CHAIN WATER,DEIONIZED POTASSIUM CHLORIDE SODIUM CITRATE SODIUM ASCORBATE MAGNESIUM CHLORIDE
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	2
NATIONAL FORMULARY NAME	FIBERSOURCE LIQUID,NUTRITIONAL SUPPLEMENT
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	NUTRITION SUPL FIBERSOURCE HN LIQUID
VA PRODUCT IDENTIFIER	F0092
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	CAN
MASTER ENTRY FOR VUID	YES
VUID	4009915
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE