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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Ascending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
25021-0814-30 25021-0814 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 15, 2012 In Use
25021-0814-67 25021-0814 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec. 1, 2013 Dec. 31, 2020 In Use
25021-0815-30 25021-0815 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 15, 2012 In Use
25021-0815-67 25021-0815 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec. 1, 2013 Sept. 30, 2020 In Use
25021-0816-30 25021-0816 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 15, 2012 In Use
25021-0816-67 25021-0816 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec. 1, 2013 Jan. 31, 2022 In Use
25021-0826-66 25021-0826 Zoledronic Acid Zoledronic Acid 0.04 mg/mL Ancillary Therapy Bisphosphonate Intravenous Sept. 1, 2015 Nov. 30, 2018 In Use
25021-0826-67 25021-0826 Zoledronic Acid Zoledronic Acid 0.04 mg/mL Ancillary Therapy Bisphosphonate Intravenous Sept. 1, 2015 In Use
25021-0826-82 25021-0826 Zoledronic Acid Zoledronic Acid 0.04 mg/mL Ancillary Therapy Bisphosphonate Intravenous March 2, 2013 In Use
31722-0525-01 31722-0525 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2010 In Use
31722-0525-05 31722-0525 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2010 In Use
31722-0525-10 31722-0525 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2010 In Use
31722-0525-30 31722-0525 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2010 In Use
31722-0525-90 31722-0525 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2010 In Use
42549-0657-30 42549-0657 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 In Use
42549-0657-60 42549-0657 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 In Use
42549-0657-90 42549-0657 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 In Use
35356-0678-20 35356-0678 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 11, 2017 In Use
35356-0678-30 35356-0678 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 11, 2012 In Use
43063-0052-02 43063-0052 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 16, 2010 Aug. 20, 2018 No Longer Used
43063-0052-04 43063-0052 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 16, 2010 Aug. 20, 2018 No Longer Used
45865-0563-10 45865-0563 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 1, 2015 In Use
45865-0563-30 45865-0563 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 1, 2015 In Use
47426-0101-01 47426-0101 Granisetron Sustol 10.0 mg/.4mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Subcutaneous Aug. 9, 2016 Aug. 9, 2016 In Use
47426-0101-06 47426-0101 Granisetron Sustol 10.0 mg/.4mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Subcutaneous Aug. 9, 2016 In Use
50090-1093-00 50090-1093 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral March 4, 2016 Jan. 31, 2018 No Longer Used
50090-1093-01 50090-1093 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral March 4, 2016 Jan. 31, 2018 No Longer Used
50090-1200-00 50090-1200 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2014 In Use
50090-1200-01 50090-1200 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2014 In Use
50090-1200-02 50090-1200 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2014 In Use
50090-1200-03 50090-1200 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 17, 2017 In Use
50742-0123-30 50742-0123 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2011 Jan. 31, 2015 No Longer Used
50742-0123-90 50742-0123 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2011 Jan. 31, 2015 No Longer Used
51862-0458-01 51862-0458 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 18, 2016 In Use
51862-0458-47 51862-0458 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 18, 2016 In Use
51862-0460-01 51862-0460 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 18, 2016 In Use
51862-0460-47 51862-0460 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 18, 2016 In Use
54569-5873-00 54569-5873 Ondansetron, ondansetron hydrochloride Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 4, 2016 In Use
54569-5873-01 54569-5873 Ondansetron, ondansetron hydrochloride Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 4, 2016 In Use
54569-5873-02 54569-5873 Ondansetron, ondansetron hydrochloride Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 4, 2016 In Use
54569-5873-03 54569-5873 Ondansetron, ondansetron hydrochloride Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 4, 2016 In Use
54569-5873-04 54569-5873 Ondansetron, ondansetron hydrochloride Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 4, 2016 In Use
54569-6168-00 54569-6168 Ondansetron, ondansetron hydrochloride Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 9, 2016 In Use
54569-6168-01 54569-6168 Ondansetron, ondansetron hydrochloride Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 9, 2016 In Use
54569-6168-02 54569-6168 Ondansetron, ondansetron hydrochloride Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 9, 2016 In Use
54569-6168-03 54569-6168 Ondansetron, ondansetron hydrochloride Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 9, 2016 In Use
55111-0172-01 55111-0172 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Feb. 28, 2007 In Use
55111-0172-05 55111-0172 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Feb. 28, 2007 In Use
55111-0172-30 55111-0172 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Feb. 28, 2007 In Use
55111-0172-78 55111-0172 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Feb. 28, 2007 In Use

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