Interchangeable Grouping
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28:00 CENTRAL NERVOUS SYSTEM DRUGS
28:24:00 SEDATIVES AND HYPNOTICS
LU Criteria Text
LORAZEPAM
4mg/mL Inj Sol (with preservative)
Interchangeables found: 2
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02041405
Ativan
(Not a Benefit)
N/A
N/A
02243278
Lorazepam Injection USP
21.2000
21.2000
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