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NOVASOURCE LIQUID,NUTRITIONAL SUPPLEMENT

Generic Name: NOVASOURCE LIQUID
Brand Names: NOVASOURCE RENAL 2 CAL
Drug Class: ENTERAL NUTRITION
Formulary Status: PA-F
Copay Tier: N/A
Last Updated: 2017-02-27

Clinical Criteria Summary

Inclusion Criteria

Provider is a VA / VA Community Care Nephrologist or Registered Dietitian
Patient has renal impairment

Source Documents

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