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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
25021-0813-10 25021-0813 Leucovorin Calcium Leucovorin Calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sep 15, 2012 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
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
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan 2, 2019 In Use
68152-0102-01 68152-0102 Levoleucovorin Fusilev 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 15, 2011 Feb 28, 2019 No Longer Used
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
72266-0120-01 72266-0120 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Jun 25, 2019 In Use
70436-0117-80 70436-0117 Leucovorin calcium Leucovorin Calcium 100.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 10, 2023 In Use
71288-0160-10 71288-0160 Leucovorin calcium Leucovorin calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 19, 2023 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
68152-0101-00 68152-0101 Levoleucovorin Fusilev 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug 15, 2008 Feb 28, 2019 No Longer Used
68462-0767-35 68462-0767 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Nov 12, 2025 In Use
68001-0286-38 68001-0286 Leucovorin Calcium Leucovorin 20.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 1, 2016 Feb 1, 2021 No Longer Used
50633-0220-04 50633-0220 Uridine triacetate VISTOGARD 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral Jul 31, 2024 In Use
69315-0184-01 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov 16, 2020 In Use
68001-0285-28 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 1, 2016 Feb 1, 2021 No Longer Used
42806-0134-34 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan 1, 2021 In Use
00054-4499-11 00054-4499 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb 22, 1993 In Use
51079-0581-01 51079-0581 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb 26, 1996 In Use
54868-3310-02 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Apr 15, 2002 In Use
67457-0529-20 67457-0529 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 23, 2019 In Use
25021-0816-67 25021-0816 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec 1, 2013 Jan 31, 2022 In Use
52125-0018-02 52125-0018 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jul 18, 2012 Jul 19, 2013 No Longer Used
00143-9553-01 00143-9553 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 23, 1995 In Use

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