HYDROCHLOROTHIAZIDE 25MG/LORSARTAN POTASSIUM 100MG TAB (13038)    VA PRODUCT (50.68)

Name Value
NAME HYDROCHLOROTHIAZIDE 25MG/LORSARTAN POTASSIUM 100MG TAB
VA GENERIC NAME HYDROCHLOROTHIAZIDE/LOSARTAN
DOSAGE FORM TAB
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2006-09-25 00:00:00
NATIONAL FORMULARY NAME HYDROCHLOROTHIAZIDE/LOSARTAN TAB
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2019-12-31 00:00:00
  • COPAY TIER LEVEL:   1
    COPAY EFFECTIVE DATE:   2020-01-01 00:00:00
    COPAY END DATE:   2022-12-31 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2023-01-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME HCTZ 25MG/LOSARTAN 100MG TAB
VA PRODUCT IDENTIFIER H0494
TRANSMIT TO CMOP YES
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4013403
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2006-09-25 00:00:00
    STATUS:   INACTIVE
  • 2006-10-11 00:00:00
    STATUS:   ACTIVE
  • 2006-09-25 00:00:00
    STATUS:   INACTIVE
  • 2006-09-25 00:00:00
    STATUS:   INACTIVE