Product Details
Ativan
Lorazepam4 mg/mL
Solution for Injection (with Preservative)
DIN/PIN/NPN
02041405
Manufacturer
Wyeth Pharmaceuticals
Formulary Listing Date
2017-02-28
Unit Price
NA
Amount MOH Pays
NA
Coverage Status
Not a Benefit
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N05BA06
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02243278 | Lorazepam Injection USP | 19.0800 | 19.0800 |
| 02041405 | Ativan | NA | NA |
| 02550962 | Lorazepam Injection, USP | 19.0800 | 19.0800 |
LU Clinical Criteria
NORequirements
NA