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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name (Ascending) Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
42806-0134-24 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
70436-0116-82 70436-0116 Leucovorin calcium Leucovorin Calcium 50.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0117-80 70436-0117 Leucovorin calcium Leucovorin Calcium 100.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0118-80 70436-0118 Leucovorin calcium Leucovorin Calcium 200.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0120-80 70436-0120 Leucovorin calcium Leucovorin Calcium 500.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
51079-0582-01 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 No Longer Used
51079-0582-05 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 June 30, 2023 No Longer Used
00703-5140-01 00703-5140 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Feb. 1, 1994 Sept. 30, 2023 No Longer Used
00703-5145-01 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous June 12, 1997 Sept. 30, 2023 No Longer Used
00703-5145-91 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 13, 2013 April 30, 2023 No Longer Used
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
69315-0185-24 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0186-24 69315-0186 Leucovorin calcium Leucovorin calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
71288-0160-10 71288-0160 Leucovorin calcium Leucovorin calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0161-20 71288-0161 Leucovorin calcium Leucovorin calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0162-30 71288-0162 Leucovorin calcium Leucovorin calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0163-30 71288-0163 Leucovorin calcium Leucovorin calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0164-50 71288-0164 Leucovorin calcium Leucovorin calcium 500.0 mg/50mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
00173-0635-35 00173-0635 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2014 No Longer Used
54868-1126-00 54868-1126 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2012 No Longer Used
54868-1126-01 54868-1126 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2012 No Longer Used
54868-1126-02 54868-1126 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2012 No Longer Used
54868-1126-03 54868-1126 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2012 No Longer Used
54868-1126-04 54868-1126 Chlorambucil Leukeran Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 June 30, 2012 No Longer Used
76388-0635-25 76388-0635 Chlorambucil Leukeran 2.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 Sept. 30, 2023 No Longer Used
76388-0635-50 76388-0635 Chlorambucil Leukeran 2.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral Feb. 13, 1985 Oct. 31, 2017 No Longer Used
50419-0002-33 50419-0002 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Sept. 5, 1991 Sept. 21, 2012 No Longer Used
50419-0050-14 50419-0050 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 5, 1991 Sept. 21, 2012 No Longer Used
50419-0050-30 50419-0050 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 5, 1991 Sept. 21, 2012 No Longer Used
54868-3188-00 54868-3188 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Dec. 1, 1996 June 30, 2012 No Longer Used
58468-0181-01 58468-0181 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 15, 2010 Dec. 31, 2013 No Longer Used
58468-0181-02 58468-0181 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 15, 2010 Dec. 31, 2013 No Longer Used
00024-5843-01 00024-5843 Sargramostim Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Nov. 5, 2013 Dec. 30, 2021 No Longer Used
00024-5843-05 00024-5843 Sargramostim Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous May 1, 1991 Dec. 30, 2021 No Longer Used
00024-5844-01 00024-5844 Sargramostim Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Dec. 1, 1996 Dec. 30, 2021 No Longer Used
00024-5844-05 00024-5844 Sargramostim Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Dec. 1, 1996 Dec. 30, 2021 No Longer Used
58468-0180-01 58468-0180 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Aug. 5, 2013 June 30, 2016 No Longer Used
58468-0180-02 58468-0180 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 15, 2010 June 30, 2016 No Longer Used
71837-5844-01 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
71837-5844-05 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
71837-5843-05 71837-5843 SARGRAMOSTIM Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Intravenous, Subcutaneous Sept. 1, 2023 In Use
41616-0936-40 41616-0936 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Subcutaneous Dec. 15, 2014 Aug. 31, 2015 No Longer Used
00703-4014-11 00703-4014 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Subcutaneous Nov. 6, 2000 March 31, 2011 No Longer Used
00703-4014-18 00703-4014 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Subcutaneous Nov. 6, 2000 March 31, 2011 No Longer Used
00781-4003-32 00781-4003 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Aug. 4, 1998 In Use
47335-0936-40 47335-0936 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Dec. 15, 2014 In Use
49884-0368-26 49884-0368 Leuprolide Acetate Leuprolide Acetate Hormonal Therapy GnRH Agonist Nov. 29, 2001 March 31, 2010 No Longer Used

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