| NAME |
RIZATRIPTAN BENZOATE 5MG TAB,ORALLY DISINTEGRATING |
| 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 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
RIZATRIPTAN TAB,ORAL DISINTEGRATING |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| 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 DISINTEGRATE TAB |
| VA PRODUCT IDENTIFIER |
R0311 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032535 |
| EFFECTIVE DATE/TIME |
-
- 2013-07-16 00:00:00
- STATUS: ACTIVE
|
