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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class (Ascending) Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
69488-0010-61 69488-0010 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous March 23, 2022 In Use
65174-0880-00 65174-0880 Sodium Iodide I 131 HICON 1000.0 mCi/mL Chemotherapy Radiopharmaceutical Iodine 131 Oral April 7, 2003 In Use
65174-0880-25 65174-0880 Sodium Iodide I 131 HICON 1000.0 mCi/mL Chemotherapy Radiopharmaceutical Iodine 131 Oral April 7, 2003 In Use
65174-0880-50 65174-0880 Sodium Iodide I 131 HICON 1000.0 mCi/mL Chemotherapy Radiopharmaceutical Iodine 131 Oral April 7, 2003 In Use
17156-0524-01 17156-0524 Strontium Chloride Sr-89 Metastron 1.0 mCi/mL Ancillary Therapy Radiopharmaceutical Strontium Sr 89 Intravenous June 18, 1993 Jan. 10, 2019 In Use
50419-0208-01 50419-0208 Radium Ra 223 dichloride Xofigo 30.0 uCi/mL Chemotherapy Radiopharmaceutical Radium 223 Intravenous May 20, 2013 In Use
71258-0015-02 71258-0015 iobenguane I-131 Azedra 15.0 mCi/mL Chemotherapy Radiopharmaceutical I 131 Intravenous July 30, 2018 In Use
71258-0015-22 71258-0015 iobenguane I-131 Azedra 15.0 mCi/mL Chemotherapy Radiopharmaceutical I 131 Intravenous July 30, 2018 In Use
00024-5840-01 00024-5840 ziv-Aflibercept Zaltrap 100.0 mg/4mL Chemotherapy Recombinant Fusion Protein VEGF-IgG1 Intravenous Aug. 3, 2012 In Use
00024-5840-03 00024-5840 ziv-Aflibercept Zaltrap 100.0 mg/4mL Chemotherapy Recombinant Fusion Protein VEGF-IgG1 Intravenous Aug. 3, 2012 Nov. 27, 2019 In Use
00024-5841-01 00024-5841 ziv-Aflibercept Zaltrap 200.0 mg/8mL, 200.0 mg/8mL Chemotherapy Recombinant Fusion Protein VEGF-IgG1 Intravenous Aug. 3, 2012 In Use
79802-0200-30 79802-0200 belumosudil Rezurock 200.0 mg/1 Chemotherapy Rho Kinase Inhibitor ROCK 1, ROCK2 Oral July 16, 2021 In Use
75929-0174-03 75929-0174 Belumosudil Rezurock 200.0 mg/1 Chemotherapy Rho Kinase Inhibitor ROCK 1, ROCK2 Oral July 16, 2021 In Use
00378-0144-05 00378-0144 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Feb. 20, 2003 Jan. 23, 2018 In Use
00378-0144-91 00378-0144 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Feb. 20, 2004 In Use
72205-0050-30 72205-0050 Toremifene citrate Toremifene citrate 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Sept. 2, 2020 In Use
69539-0152-30 69539-0152 Toremifene citrate Toremifene citrate 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 20, 2020 In Use
64980-0404-03 64980-0404 Toremifene Citrate Toremifene Citrate 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 18, 2019 In Use
00002-4165-02 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 6, 1998 Dec. 31, 2017 No Longer Used
00002-4165-07 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 6, 1998 Nov. 30, 2017 No Longer Used
00002-4165-30 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 6, 1998 Jan. 31, 2018 No Longer Used
00002-4165-34 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 6, 1998 Jan. 25, 2011 No Longer Used
00002-4165-61 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 10, 2010 April 3, 2015 No Longer Used
00002-4165-79 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 6, 1998 Jan. 25, 2011 No Longer Used
00002-4165-99 00002-4165 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 6, 2009 March 5, 2012 No Longer Used

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