DILTIAZEM (TIAZAC) 120MG SA CAP,UD (13057)    VA PRODUCT (50.68)

Name Value
NAME DILTIAZEM (TIAZAC) 120MG SA CAP,UD
VA GENERIC NAME DILTIAZEM
DOSAGE FORM CAP,SA
ACTIVE INGREDIENTS
NATIONAL FORMULARY RESTRICTION 
Refer to PBM/MAP Hypertension treatment and CHF treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 120
INACTIVATION DATE 2012-05-03 00:00:00
UNITS MG
NATIONAL FORMULARY NAME DILTIAZEM CAP,SA
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME DILTIAZEM (TIAZAC) 120MG SA CAP UD
VA PRODUCT IDENTIFIER D0431
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4013422
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2012-05-03 00:00:00
    STATUS:   INACTIVE
  • 2012-05-03 00:00:00
    STATUS:   INACTIVE