RIZATRIPTAN BENZOATE 10MG TAB,PKG,12 (18669)    VA PRODUCT (50.68)

Name Value
NAME RIZATRIPTAN BENZOATE 10MG TAB,PKG,12
VA GENERIC NAME RIZATRIPTAN
DOSAGE FORM TAB
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 2018-10-15 00:00:00
UNITS MG
NATIONAL FORMULARY NAME RIZATRIPTAN TAB
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 BENZOATE 10MG TAB PKG 12
VA PRODUCT IDENTIFIER R0222
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKT
MASTER ENTRY FOR VUID YES
VUID 4026469
EFFECTIVE DATE/TIME
  • 2007-08-30 00:00:00
    STATUS:   ACTIVE
  • 2012-01-19 00:00:00
    STATUS:   INACTIVE
  • 2018-10-15 00:00:00
    STATUS:   INACTIVE