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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
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
70518-3075-00 70518-3075 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 20, 2021 In Use
70518-3075-01 70518-3075 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 13, 2021 In Use
71731-5111-01 71731-5111 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 16, 2021 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
67457-0864-04 67457-0864 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous March 21, 2018 In Use
00093-5741-19 00093-5741 Cyclosporine Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5741-65 00093-5741 Cyclosporine Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5742-19 00093-5742 Cyclosporine Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00093-5742-65 00093-5742 Cyclosporine Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 1, 2015 Jan. 31, 2023 No Longer Used
00781-3201-94 00781-3201 Levoleucovorin Levoleucovorin 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous April 23, 2015 April 30, 2023 No Longer Used
00904-6745-61 00904-6745 DRONABINOL DRONABINOL 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 26, 2018 Jan. 31, 2023 No Longer Used
00904-6746-04 00904-6746 DRONABINOL DRONABINOL 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 26, 2018 Jan. 31, 2023 No Longer Used
89141-0444-01 89141-0444 Ondansetron Zuplenz 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 2, 2010 Feb. 23, 2023 No Longer Used
89141-0444-30 89141-0444 Ondansetron Zuplenz 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 31, 2016 Feb. 23, 2023 No Longer Used
35356-0197-30 35356-0197 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 10, 2010 Dec. 31, 2015 In Use
35356-0197-65 35356-0197 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 10, 2010 In Use
50090-1660-00 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 In Use
50090-1660-01 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 In Use
50090-1660-02 50090-1660 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 23, 2015 In Use
42806-0134-34 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
42806-0134-24 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
47426-0401-10 47426-0401 APREPITANT APONVIE 32.0 mg/4.4mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 6, 2023 In Use
51655-0008-20 51655-0008 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 31, 2022 In Use
51655-0008-53 51655-0008 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 8, 2022 In Use
51655-0016-27 51655-0016 Ondansetron Hydrochloride Ondansetron Hydrochloride 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2022 In Use
51655-0016-53 51655-0016 Ondansetron Hydrochloride Ondansetron Hydrochloride 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2022 In Use
51655-0016-54 51655-0016 Ondansetron Hydrochloride Ondansetron Hydrochloride 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 8, 2022 In Use
51655-0016-87 51655-0016 Ondansetron Hydrochloride Ondansetron Hydrochloride 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 21, 2022 In Use
51655-0809-53 51655-0809 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 6, 2022 In Use
51655-0809-87 51655-0809 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 30, 2020 In Use
51655-0809-04 51655-0809 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 7, 2022 In Use
51655-0913-20 51655-0913 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 3, 2022 In Use
51655-0913-53 51655-0913 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 22, 2021 In Use
51655-0699-53 51655-0699 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 2, 2021 In Use
51655-0813-54 51655-0813 Ondansetron Hydrochloride Ondansetron Hydrochloride 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 10, 2021 In Use
60760-0636-10 60760-0636 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
60760-0636-20 60760-0636 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 26, 2018 In Use
60760-0636-30 60760-0636 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 15, 2019 In Use
60760-0636-16 60760-0636 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 3, 2023 In Use
61919-0565-10 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 12, 2018 In Use
61919-0565-12 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 6, 2019 In Use
61919-0565-20 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 23, 2016 In Use
61919-0565-30 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 22, 2019 In Use
61919-0565-90 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 22, 2019 In Use
61919-0565-60 61919-0565 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 6, 2019 In Use
63187-0379-03 63187-0379 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 1, 2017 In Use

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