Product Details

Ativan

Lorazepam
4 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	21.2000	21.2000
02041405	Ativan	NA	NA

LU Clinical Criteria

NO

Requirements

NA

EAP Criteria

NO

Product Monograph