HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG TAB (2145)    VA PRODUCT (50.68)

Name Value
NAME HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG TAB
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
DSS NUMBER 1
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 50/TRIAMTERENE 75MG TAB
VA PRODUCT IDENTIFIER H0051
TRANSMIT TO CMOP YES
VA DISPENSE UNIT TAB
MASTER ENTRY FOR VUID YES
VUID 4002728
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE