| NAME |
RIZATRIPTAN BENZOATE 10MG TAB |
| VA GENERIC NAME |
RIZATRIPTAN |
| DOSAGE FORM |
TAB |
| FORMULARY DESIGNATOR TEXT |
Dispense limit of 18 doses of oral triptans per month
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
10 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
RIZATRIPTAN TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
RIZATRIPTAN BENZOATE 10MG TAB |
| VA PRODUCT IDENTIFIER |
R0095 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4013272 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2012-01-19 00:00:00
- STATUS: INACTIVE
|
