RIZATRIPTAN BENZOATE 10MG,ORALLY DISINTEGRATING,PKG,3 (15162)    VA PRODUCT (50.68)

Name Value
NAME RIZATRIPTAN BENZOATE 10MG,ORALLY DISINTEGRATING,PKG,3
VA GENERIC NAME RIZATRIPTAN
DOSAGE FORM TAB,ORAL DISINTEGRATING
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
INACTIVATION DATE 2018-09-18 00:00:00
UNITS MG
NATIONAL FORMULARY NAME RIZATRIPTAN TAB,ORAL DISINTEGRATING
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE 1x Possible Dosage
PACKAGE Both Inpatient and Outpatient
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 RIZATRIPTAN 10MG DISINTEGRATE TAB PKG 3
VA PRODUCT IDENTIFIER R0141
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKG
MASTER ENTRY FOR VUID YES
VUID 4015526
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2012-01-19 00:00:00
    STATUS:   INACTIVE
  • 2018-09-18 00:00:00
    STATUS:   INACTIVE