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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
00078-0182-61 00078-0182 Octreotide Acetate Sandostatin 500.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Aug. 13, 2012 In Use
68084-0075-11 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 In Use
68084-0075-21 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 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
00591-5052-01 00591-5052 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5052-10 00591-5052 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5052-21 00591-5052 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 25, 2016 In Use
00591-5052-43 00591-5052 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 25, 2016 In Use
00591-5442-01 00591-5442 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5442-05 00591-5442 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5442-10 00591-5442 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 18, 1993 In Use
00591-5442-21 00591-5442 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 25, 2016 In Use
00591-5442-43 00591-5442 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 25, 2016 In Use
00591-5443-01 00591-5443 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5443-05 00591-5443 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 1990 In Use
00591-5443-10 00591-5443 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Nov. 11, 1993 In Use
00078-0109-01 00078-0109 Cyclosporine Sandimmune 50.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Intravenous Nov. 14, 1983 In Use
00078-0109-61 00078-0109 Cyclosporine Sandimmune 50.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Intravenous Aug. 10, 2012 In Use
00078-0240-15 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use
00078-0240-61 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 22, 2010 In Use
00078-0241-15 00078-0241 Cyclosporine Sandimmune 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use
00078-0241-61 00078-0241 Cyclosporine Sandimmune 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 22, 2010 In Use
00074-7269-50 00074-7269 Cyclosporine Modified Gengraf 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 25, 2010 In Use
00078-0246-15 00078-0246 Cyclosporine NeOral 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 14, 1995 In Use
00078-0246-61 00078-0246 Cyclosporine NeOral 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Aug. 13, 2012 In Use
00078-0248-15 00078-0248 Cyclosporine Modified NeOral 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 14, 1995 In Use
00078-0248-61 00078-0248 Cyclosporine Modified NeOral 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Aug. 13, 2012 In Use
55513-0005-01 55513-0005 Darbepoetin alfa Aranesp 100.0 ug/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Sept. 11, 2006 In Use
55513-0005-04 55513-0005 Darbepoetin alfa Aranesp 100.0 ug/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Sept. 11, 2006 In Use
55513-0027-01 55513-0027 Darbepoetin alfa Aranesp 150.0 ug/.3mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Feb. 18, 2011 In Use
55513-0027-04 55513-0027 Darbepoetin alfa Aranesp 150.0 ug/.3mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Sept. 11, 2006 In Use
00944-2656-03 00944-2656 Human Immunoglobulin G Gammagard S/D Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 In Use
00944-2658-04 00944-2658 Human Immunoglobulin G Gammagard S/D Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 In Use
00054-0143-07 00054-0143 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 24, 2008 In Use
00054-0143-08 00054-0143 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 31, 2007 In Use
00054-0143-87 00054-0143 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 24, 2008 In Use
00143-9554-01 00143-9554 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous March 28, 1988 In Use
00143-9555-01 00143-9555 Leucovorin Calcium Leucovorin Calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 14, 1987 In Use
00143-9558-01 00143-9558 Levoleucovorin Levoleucovorin 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous July 7, 2016 In Use
70121-1099-01 70121-1099 Levoleucovorin Levoleucovorin 50.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intravenous Feb. 13, 2017 In Use
00338-1305-01 00338-1305 Mesna Mesnex 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Dec. 30, 1988 In Use
00338-1305-03 00338-1305 Mesna Mesnex 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Dec. 30, 1988 In Use
00187-1221-03 00187-1221 Nabilone Cesamet 1.0 mg/1 Ancillary Therapy Antiemetic Cannabinoid Oral Nov. 1, 2009 Nov. 13, 2017 No Longer Used
00069-0107-01 00069-0107 Pamidronate Disodium Pamidronate Disodium 3.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 10, 2011 Dec. 31, 2017 No Longer Used
00069-0109-01 00069-0109 Pamidronate Disodium Pamidronate Disodium 9.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 10, 2011 Dec. 31, 2017 No Longer Used
00069-0186-01 00069-0186 Pamidronate Disodium Pamidronate Disodium 3.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 10, 2011 Dec. 31, 2017 No Longer Used
55700-0484-10 55700-0484 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 13, 2017 In Use
55700-0484-12 55700-0484 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 13, 2017 In Use
55700-0484-20 55700-0484 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 13, 2017 In Use

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