TRIMETHOBENZAMIDE HCL 250MG CAP (4110)    VA PRODUCT (50.68)

Name Value
NAME TRIMETHOBENZAMIDE HCL 250MG CAP
VA GENERIC NAME TRIMETHOBENZAMIDE
DOSAGE FORM CAP,ORAL
FORMULARY DESIGNATOR PA-F
FORMULARY DESIGNATOR TEXT 
Restricted to use with Apomorphine
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR NO
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 250
INACTIVATION DATE 2010-02-03 00:00:00
UNITS MG
DSS NUMBER 2
NATIONAL FORMULARY NAME TRIMETHOBENZAMIDE 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 TRIMETHOBENZAMIDE HCL 250MG CAP
VA PRODUCT IDENTIFIER T0117
TRANSMIT TO CMOP YES
VA DISPENSE UNIT CAP
MASTER ENTRY FOR VUID YES
VUID 4004662
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2010-02-03 00:00:00
    STATUS:   INACTIVE