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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
50742-0183-24 50742-0183 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 30, 2020 In Use
50742-0184-25 50742-0184 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 30, 2020 In Use
76310-0017-50 76310-0017 Amifostine Ethyol 500.0 mg/10mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Jan. 1, 2020 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 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
71288-0105-25 71288-0105 Levoleucovorin calcium Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 16, 2019 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
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

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