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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
54868-1743-00 54868-1743 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 5, 2007 In Use
54868-1743-01 54868-1743 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 5, 2007 In Use
54868-1743-02 54868-1743 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 5, 2007 In Use
54868-1743-03 54868-1743 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 5, 2007 In Use
54868-1743-04 54868-1743 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 5, 2007 In Use
54868-1744-00 54868-1744 Dexamethasone Dexamethasone 1.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 21, 1996 In Use
54868-1994-00 54868-1994 Methylprednisolone Acetate Methylprednisolone Acetate Hormonal Therapy Adrenal Glucocorticoid Corticosteroid March 5, 2009 April 16, 2012 No Longer Used
54868-2522-00 54868-2522 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous June 8, 1994 In Use
54868-2522-01 54868-2522 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous June 8, 1994 In Use
54868-2523-01 54868-2523 Erythropoietin Procrit 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Aug. 11, 1994 In Use
54868-2702-00 54868-2702 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Nov. 16, 2004 In Use
54868-2702-01 54868-2702 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Nov. 16, 2004 In Use
54868-2913-00 54868-2913 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 15, 2009 In Use
54868-2913-01 54868-2913 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 15, 2009 In Use
54868-2913-02 54868-2913 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 15, 2009 In Use
54868-2913-03 54868-2913 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 15, 2009 In Use
54868-2984-00 54868-2984 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 2.5 mg/1 Hormonal Therapy Progestin Oral April 24, 1995 In Use
54868-2984-02 54868-2984 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 2.5 mg/1 Hormonal Therapy Progestin Oral April 24, 1995 In Use
54868-2984-03 54868-2984 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 2.5 mg/1 Hormonal Therapy Progestin Oral April 24, 1995 In Use
54868-2985-00 54868-2985 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Sept. 19, 1995 In Use
54868-2985-01 54868-2985 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Sept. 19, 1995 In Use
54868-2985-02 54868-2985 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Sept. 19, 1995 In Use
54868-2985-03 54868-2985 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Sept. 19, 1995 In Use
54868-3004-01 54868-3004 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral April 26, 1994 Nov. 7, 2011 In Use
54868-3004-02 54868-3004 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral April 26, 1994 In Use
54868-3004-03 54868-3004 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral April 26, 1994 In Use
54868-3004-04 54868-3004 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral April 26, 1994 In Use
54868-3004-05 54868-3004 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral April 26, 1994 In Use
54868-3050-00 54868-3050 Filgrastim Neupogen 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous Aug. 14, 2006 In Use
54868-3084-00 54868-3084 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 11, 1994 March 31, 2014 No Longer Used
54868-3084-01 54868-3084 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 11, 1994 March 31, 2014 No Longer Used
54868-3084-02 54868-3084 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 11, 1994 March 31, 2014 No Longer Used
54868-3157-00 54868-3157 Dexamethasone Dexamethasone 2.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 21, 2005 In Use
54868-3157-01 54868-3157 Dexamethasone Dexamethasone 2.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 21, 2005 In Use
54868-3188-00 54868-3188 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Dec. 1, 1996 June 30, 2012 No Longer Used
54868-3189-00 54868-3189 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral June 7, 2005 June 30, 2011 No Longer Used
54868-3189-01 54868-3189 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral June 7, 2005 June 30, 2011 No Longer Used
54868-3189-02 54868-3189 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral June 7, 2005 June 30, 2011 No Longer Used
54868-3189-03 54868-3189 Dronabinol Marinol Ancillary Therapy Antiemetic CB1/CB2 Oral June 7, 2005 June 30, 2011 No Longer Used
54868-3310-00 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral April 15, 2002 In Use
54868-3310-01 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral April 15, 2002 In Use
54868-3310-02 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral April 15, 2002 In Use
54868-3310-03 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral April 15, 2002 In Use
54868-3310-04 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral April 15, 2002 In Use
54868-3344-00 54868-3344 Triamcinolone Hexacetonide Aristospan Hormonal Therapy Adrenal Glucocorticoid Corticosteroid July 12, 1994 June 30, 2011 No Longer Used
54868-3348-01 54868-3348 Medroxyprogesterone Acetate Depo-Provera 400.0 mg/mL Hormonal Therapy Progestin Intramuscular Jan. 13, 1995 In Use
54868-3613-00 54868-3613 Medroxyprogesterone Acetate Depo-Provera Hormonal Therapy Progestin Jan. 24, 2000 June 30, 2011 No Longer Used
54868-3623-00 54868-3623 Methylprednisolone Sodium Succinate Solu-Medrol Hormonal Therapy Adrenal Glucocorticoid Corticosteroid April 16, 2013 June 30, 2010 No Longer Used
54868-3637-00 54868-3637 Methylprednisolone Sodium Succinate Solu-Medrol Hormonal Therapy Adrenal Glucocorticoid Corticosteroid April 16, 2013 June 30, 2010 No Longer Used
54868-3637-01 54868-3637 Methylprednisolone Sodium Succinate Solu-Medrol Hormonal Therapy Adrenal Glucocorticoid Corticosteroid April 16, 2013 June 30, 2010 No Longer Used

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