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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
16714-0890-01 16714-0890 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
71288-0104-10 71288-0104 Levoleucovorin calcium Levoleucovorin 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug 22, 2019 Apr 30, 2024 No Longer Used
25021-0815-30 25021-0815 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sep 15, 2012 In Use
71205-0908-60 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jul 16, 2021 In Use
69315-0186-24 69315-0186 Leucovorin calcium Leucovorin calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov 16, 2020 In Use
68001-0285-40 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 1, 2016 Feb 1, 2021 No Longer Used
69468-0151-04 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral Mar 1, 2016 In Use
25021-0814-30 25021-0814 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sep 15, 2012 In Use
54868-3310-00 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Apr 15, 2002 In Use
00703-5145-91 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 13, 2013 Apr 30, 2023 No Longer Used
70860-0209-11 70860-0209 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Feb 28, 2018 In Use
72205-0248-01 72205-0248 Dexrazoxane Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Apr 9, 2025 In Use
68001-0649-37 68001-0649 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 10, 2025 In Use
70436-0209-80 70436-0209 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug 1, 2023 In Use
55390-0060-02 55390-0060 Dexrazoxane Dexrazoxane Ancillary Therapy Chemoprotective Detoxifying Agent Mar 31, 2005 May 31, 2013 No Longer Used
68083-0279-01 68083-0279 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 20, 2018 In Use
71205-0908-90 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jul 16, 2021 In Use
71288-0162-30 71288-0162 Leucovorin calcium Leucovorin calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 19, 2023 In Use
50242-0918-01 50242-0918 Atezolizumab TECENTRIQ 840.0 mg/14mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Mar 8, 2019 In Use
50881-0006-03 50881-0006 Retifanlimab-dlwr ZYNYZ 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Mar 22, 2023 In Use
00310-4500-12 00310-4500 Durvalumab Imfinzi 120.0 mg/2.4mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 1, 2017 In Use
50242-0917-86 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Aug 11, 2016 In Use
00003-3772-11 00003-3772 Nivolumab Opdivo 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Dec 22, 2014 In Use
00003-2328-22 00003-2328 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous Mar 25, 2011 In Use
83718-0000-01 83718-0000 Toripalimab-tpzi LOQTORZI 240.0 mg/6mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Oct 27, 2023 In Use

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