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  

EAP Criteria

NO

Product Monograph

View Monograph