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NDC-11 (Package) NDC-9 (Product) (Ascending) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
54868-4142-06 54868-4142 Temozolomide Temodar 20.0 mg/1 Chemotherapy Alkylating Agent Tetrazine Oral June 29, 2005 In Use
54868-4143-00 54868-4143 Capecitabine Xeloda 150.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Feb. 20, 2005 In Use
54868-4151-00 54868-4151 Letrozole Femara 2.5 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Feb. 10, 2005 In Use
54868-4170-00 54868-4170 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral May 11, 2000 In Use
54868-4170-01 54868-4170 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral May 11, 2000 In Use
54868-4287-00 54868-4287 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 2005 In Use
54868-4287-01 54868-4287 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 2005 In Use
54868-4287-02 54868-4287 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 2005 In Use
54868-4287-03 54868-4287 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 2005 In Use
54868-4287-04 54868-4287 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 2005 In Use
54868-4339-00 54868-4339 Melphalan Alkeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 15, 2005 June 30, 2012 No Longer Used
54868-4339-01 54868-4339 Melphalan Alkeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 15, 2005 June 30, 2012 No Longer Used
54868-4339-03 54868-4339 Melphalan Alkeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 15, 2005 June 30, 2012 No Longer Used
54868-4339-04 54868-4339 Melphalan Alkeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 15, 2005 June 30, 2012 No Longer Used
54868-4370-00 54868-4370 Estradiol Estradiol 0.5 mg/1 Hormonal Therapy Estrogen Oral June 9, 2003 In Use
54868-4370-01 54868-4370 Estradiol Estradiol 0.5 mg/1 Hormonal Therapy Estrogen Oral June 9, 2003 In Use
54868-4370-02 54868-4370 Estradiol Estradiol 0.5 mg/1 Hormonal Therapy Estrogen Oral June 9, 2003 In Use
54868-4503-00 54868-4503 Bicalutamide Casodex 50.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor Non-Steroidal Oral June 4, 2002 In Use
54868-4554-01 54868-4554 Imiquimod Aldara Immunotherapy Immunomodulator Dermatological Agent Topical June 19, 2003 Sept. 30, 2009 No Longer Used
54868-4628-00 54868-4628 Flutamide Flutamide Hormonal Therapy Androgen Receptor Inhibitor Non-Steroidal Oral Sept. 18, 2001 June 30, 2004 No Longer Used
54868-4716-00 54868-4716 Methotrexate Sodium Methotrexate Chemotherapy Antimetabolite Folic Acid Analog Intravenous, subcutaneous, intramuscular Dec. 16, 2002 Dec. 31, 2010 No Longer Used
54868-4748-00 54868-4748 prednisolone Prednisolone 5.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 28, 2003 In Use
54868-4749-00 54868-4749 prednisolone Prednisolone 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 28, 2003 In Use
54868-4749-01 54868-4749 prednisolone Prednisolone 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 28, 2003 In Use
54868-4773-00 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-01 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-02 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-03 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-04 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4865-00 54868-4865 Estrogens, Conjugated Premarin Hormonal Therapy Estrogen Oral July 25, 2003 June 30, 2013 No Longer Used
54868-4952-00 54868-4952 Methylprednisolone Medrol Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Nov. 28, 1994 June 30, 2011 No Longer Used
54868-4952-01 54868-4952 Methylprednisolone Medrol Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Nov. 28, 1994 June 30, 2011 No Longer Used
54868-5000-00 54868-5000 Anastrozole Arimidex 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Feb. 19, 2004 In Use
54868-5005-00 54868-5005 Cyclophosphamide Cyclophosphamide 50.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 17, 1999 In Use
54868-5020-00 54868-5020 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous March 11, 2004 In Use
54868-5039-00 54868-5039 Isotretinoin Amnesteem 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Nov. 2, 2010 In Use
54868-5041-00 54868-5041 Isotretinoin Amnesteem 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 14, 2009 In Use
54868-5043-00 54868-5043 Isotretinoin Amnesteem 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 14, 2009 In Use
54868-5089-00 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5089-01 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5089-02 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5089-03 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5089-04 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5089-05 54868-5089 Ondansetron Zofran ODT Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 9, 2004 June 30, 2011 No Longer Used
54868-5114-00 54868-5114 Dutasteride Avodart 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral July 16, 2004 In Use
54868-5114-01 54868-5114 Dutasteride Avodart 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral July 16, 2004 In Use
54868-5213-00 54868-5213 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 25, 2005 In Use
54868-5218-00 54868-5218 Cyclophosphamide Cyclophosphamide 25.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 17, 1999 In Use
54868-5218-01 54868-5218 Cyclophosphamide Cyclophosphamide 25.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral Aug. 17, 1999 In Use
54868-5229-00 54868-5229 Pegfilgrastim Neulasta Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Feb. 23, 2006 Dec. 31, 2011 No Longer Used

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