HYDROCHLOROTHIAZIDE 12.5MG/LOSARTAN POTASSIUM 50MG TAB,UD (13056) VA PRODUCT (50.68)

Name	Value
NAME	HYDROCHLOROTHIAZIDE 12.5MG/LOSARTAN POTASSIUM 50MG TAB,UD
VA GENERIC NAME	HYDROCHLOROTHIAZIDE/LOSARTAN
DOSAGE FORM	TAB
ACTIVE INGREDIENTS	HYDROCHLOROTHIAZIDE STRENGTH: 12.5 UNITS: MG LOSARTAN POTASSIUM STRENGTH: 50 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
INACTIVATION DATE	2020-07-15 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 12.5/LOSARTAN 50MG TAB UD
VA PRODUCT IDENTIFIER	H0493
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	TAB
MASTER ENTRY FOR VUID	YES
VUID	4013421
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2020-07-15 00:00:00 STATUS: INACTIVE