HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG TAB,UD (13618)    VA PRODUCT (50.68)

Name Value
NAME HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG TAB,UD
VA GENERIC NAME HYDROCHLOROTHIAZIDE/TRIAMTERENE
DOSAGE FORM TAB
ACTIVE INGREDIENTS
NATIONAL FORMULARY RESTRICTION 
Refer to PBM/MAP Hypertension treatment and CHF treatment guidelines
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
INACTIVATION DATE 2021-12-15 00:00:00
NATIONAL FORMULARY NAME HYDROCHLOROTHIAZIDE/TRIAMTERENE TAB
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   1
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME HCTZ 50MG/TRIAMTERENE 75MG TAB UD
VA PRODUCT IDENTIFIER H0382
TRANSMIT TO CMOP NO
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4013983
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2021-12-15 00:00:00
    STATUS:   INACTIVE