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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class (Descending) Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
70436-0116-82 70436-0116 Leucovorin calcium Leucovorin Calcium 50.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0117-80 70436-0117 Leucovorin calcium Leucovorin Calcium 100.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0118-80 70436-0118 Leucovorin calcium Leucovorin Calcium 200.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0120-80 70436-0120 Leucovorin calcium Leucovorin Calcium 500.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 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
70436-0210-80 70436-0210 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 1, 2023 In Use
71288-0160-10 71288-0160 Leucovorin calcium Leucovorin calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0161-20 71288-0161 Leucovorin calcium Leucovorin calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0162-30 71288-0162 Leucovorin calcium Leucovorin calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0163-30 71288-0163 Leucovorin calcium Leucovorin calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0164-50 71288-0164 Leucovorin calcium Leucovorin calcium 500.0 mg/50mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
68083-0388-01 68083-0388 Dexrazoxane for Injection Dexrazoxane 250.0 mg/25mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Dec. 16, 2019 In Use
00003-7125-11 00003-7125 nivolumab and relatlimab-rmbw OPDUALAG 12.0 mg/mL, 4.0 mg/mL Immunotherapy Checkpoint Inhibitor, Monoclonal Antibody PD-1, LAG3 Intravenous March 18, 2022 In Use
50242-0917-01 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 18, 2016 In Use
50242-0917-86 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Aug. 11, 2016 In Use
00173-0898-03 00173-0898 dostarlimab Jemperli 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous April 22, 2021 In Use
00006-3026-02 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Jan. 15, 2015 In Use
00006-3026-04 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Aug. 1, 2019 In Use
61755-0008-01 61755-0008 cemiplimab-rwlc LIBTAYO 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Sept. 28, 2018 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
00310-4611-50 00310-4611 Durvalumab Imfinzi 500.0 mg/10mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 1, 2017 In Use
00003-3772-11 00003-3772 Nivolumab Opdivo 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Dec. 22, 2014 In Use
00003-3774-12 00003-3774 Nivolumab Opdivo 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Dec. 22, 2014 In Use
44087-3535-01 44087-3535 Avelumab Bavencio 20.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous March 23, 2017 In Use
00003-2328-22 00003-2328 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous March 25, 2011 In Use

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