HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG CAP (2149)    VA PRODUCT (50.68)

Name Value
NAME HYDROCHLOROTHIAZIDE 50MG/TRIAMTERENE 75MG 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
INACTIVATION DATE 2002-10-22 00:00:00
DSS NUMBER 5
NATIONAL FORMULARY NAME HYDROCHLOROTHIAZIDE/TRIAMTERENE CAP,ORAL
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 HCTZ 50/TRIAMTERENE 75MG CAP
VA PRODUCT IDENTIFIER H0145
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4002732
EFFECTIVE DATE/TIME
  • 2002-10-22 00:00:00
    STATUS:   INACTIVE
  • 2005-12-08 00:00:00
    STATUS:   INACTIVE