RIZATRIPTAN BENZOATE 5MG TAB,ORALLY DISINTEGRATING,PKG,3 (15163)    VA PRODUCT (50.68)

Name Value
NAME RIZATRIPTAN BENZOATE 5MG TAB,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 5
INACTIVATION DATE 2018-09-18 00:00:00
UNITS MG
NATIONAL FORMULARY NAME RIZATRIPTAN TAB,ORAL DISINTEGRATING
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 RIZATRIPTAN 5MG DISINTERGRATE TAB PKG 3
VA PRODUCT IDENTIFIER R0142
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKG
MASTER ENTRY FOR VUID YES
VUID 4015527
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2005-11-01 00:00:00
    STATUS:   INACTIVE
  • 2018-09-18 00:00:00
    STATUS:   INACTIVE