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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
50633-0220-04 50633-0220 Uridine triacetate VISTOGARD 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral Jul 31, 2024 In Use
69315-0184-03 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov 16, 2020 In Use
43598-0771-11 43598-0771 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
55390-0051-10 55390-0051 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 Aug 31, 2013 No Longer Used
50742-0182-12 50742-0182 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jul 30, 2020 In Use
16714-0890-01 16714-0890 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
51079-0582-01 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug 27, 1997 No Longer Used
71288-0163-30 71288-0163 Leucovorin calcium Leucovorin calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 19, 2023 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
69315-0185-12 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov 16, 2020 In Use
63323-0631-50 63323-0631 Leucovorin Calcium Leucovorin Calcium 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 27, 2018 In Use
42806-0134-34 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan 1, 2021 In Use
67457-0528-10 67457-0528 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 23, 2019 In Use
00703-5145-01 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jun 12, 1997 Sep 30, 2023 No Longer Used
71288-0164-50 71288-0164 Leucovorin calcium Leucovorin calcium 500.0 mg/50mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 19, 2023 In Use
60687-0227-94 60687-0227 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb 17, 2017 In Use
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov 16, 2020 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
25021-0815-67 25021-0815 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec 1, 2013 Sep 30, 2020 In Use
16714-0915-01 16714-0915 LEVOLEUCOVORIN LEVOLEUCOVORIN 250.0 mg/25mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
45963-0762-57 45963-0762 Levoleucovorin Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Feb 14, 2017 Jul 31, 2019 In Use
71288-0105-18 71288-0105 Levoleucovorin calcium Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug 16, 2019 In Use
50742-0495-25 50742-0495 Levoleucovorin LEVOLEUCOVORIN 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous May 8, 2018 Jun 30, 2021 In Use
71205-0908-11 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jul 16, 2021 In Use
42806-0359-25 42806-0359 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Apr 16, 2020 In Use

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