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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Ascending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
69315-0184-03 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 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
69315-0185-24 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 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
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
70518-3075-00 70518-3075 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 20, 2021 In Use
70518-3075-01 70518-3075 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 13, 2021 In Use
71731-5111-01 71731-5111 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 16, 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
67457-0864-04 67457-0864 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous March 21, 2018 In Use
00093-5741-19 00093-5741 Cyclosporine Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5741-65 00093-5741 Cyclosporine Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5742-19 00093-5742 Cyclosporine Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5742-65 00093-5742 Cyclosporine Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00781-3201-94 00781-3201 Levoleucovorin Levoleucovorin 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous April 23, 2015 April 30, 2023 No Longer Used
00904-6745-61 00904-6745 DRONABINOL DRONABINOL 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 26, 2018 Jan. 31, 2023 No Longer Used
00904-6746-04 00904-6746 DRONABINOL DRONABINOL 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 26, 2018 Jan. 31, 2023 No Longer Used
89141-0444-01 89141-0444 Ondansetron Zuplenz 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 2, 2010 Feb. 23, 2023 No Longer Used
89141-0444-30 89141-0444 Ondansetron Zuplenz 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 31, 2016 Feb. 23, 2023 No Longer Used
35356-0197-30 35356-0197 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 10, 2010 Dec. 31, 2015 In Use
35356-0197-65 35356-0197 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 10, 2010 In Use
50090-1660-00 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 In Use
50090-1660-01 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 In Use
50090-1660-02 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 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

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