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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
63459-0912-15 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 11, 2013 In Use
63459-0912-17 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 2, 2015 In Use
63459-0912-18 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Jan. 7, 2015 In Use
63459-0912-36 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 2, 2015 In Use
00004-0357-30 00004-0357 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous March 29, 2011 June 30, 2024 In Use
00004-0357-99 00004-0357 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Aug. 22, 2011 Sept. 19, 2014 In Use
63459-0920-59 63459-0920 tbo-filgrastim GRANIX 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 7, 2018 In Use
63459-0918-59 63459-0918 tbo-filgrastim GRANIX 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 7, 2018 In Use
63629-2612-01 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-02 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-03 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-04 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-05 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-06 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
63629-2612-07 63629-2612 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Nov. 29, 2022 In Use
68382-0826-01 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0826-05 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 Dec. 5, 2019 In Use
68382-0826-06 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 Dec. 5, 2019 In Use
68382-0826-14 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0826-16 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0826-28 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0826-77 68382-0826 Tamoxifen Citrate Tamoxifen Citrate 10.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 Dec. 5, 2019 In Use
52584-0239-30 52584-0239 dexamethasone sodium phosphate DEXAMETHASONE SODIUM PHOSPHATE 4.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-articular, Intralesional, Intramuscular, Intravenous, Soft Tissue Aug. 9, 2019 Aug. 31, 2023 In Use
52584-0420-10 52584-0420 Dexamethasone Sodium Phosphate Dexamethasone Sodium Phosphate 10.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous May 26, 2014 Jan. 31, 2024 In Use
68382-0827-01 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0827-05 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 Dec. 5, 2019 In Use
68382-0827-06 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0827-10 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0827-14 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0827-16 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 In Use
68382-0827-77 68382-0827 Tamoxifen Citrate Tamoxifen Citrate 20.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 3, 2018 Dec. 5, 2019 In Use
68788-7752-00 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-01 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-02 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-03 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-04 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-05 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-06 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-08 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
68788-7752-09 68788-7752 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 1, 2020 Aug. 30, 2023 In Use
70771-1058-00 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-01 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-02 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-03 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-05 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-07 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
70771-1058-09 70771-1058 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 9, 2017 In Use
69448-0005-12 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Aug. 31, 2023 In Use
69448-0005-31 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Nov. 30, 2022 In Use
69448-0005-33 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Nov. 30, 2022 In Use

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