HYDROCHLOROTHIAZIDE 25MG/TRIAMTERENE 50MG CAP (2146)    VA PRODUCT (50.68)

Name Value
NAME HYDROCHLOROTHIAZIDE 25MG/TRIAMTERENE 50MG CAP
VA GENERIC NAME HYDROCHLOROTHIAZIDE/TRIAMTERENE
DOSAGE FORM CAP,ORAL
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 2
NATIONAL FORMULARY NAME HYDROCHLOROTHIAZIDE/TRIAMTERENE CAP,ORAL
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 25/TRIAMTERENE 50MG CAP
VA PRODUCT IDENTIFIER H0047
TRANSMIT TO CMOP NO
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4002729
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE