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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
00054-4496-13 00054-4496 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-4496-25 00054-4496 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-4497-05 00054-4497 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-4497-10 00054-4497 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-4498-10 00054-4498 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-4499-11 00054-4499 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00054-8496-19 00054-8496 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb. 22, 1993 In Use
00555-0485-04 00555-0485 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral June 30, 1990 In Use
00555-0485-27 00555-0485 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral June 30, 1990 In Use
52125-0018-02 52125-0018 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 18, 2012 July 19, 2013 No Longer Used
52125-0453-02 52125-0453 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral March 12, 2013 March 12, 2014 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
54868-5915-00 54868-5915 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 8, 2008 In Use
55390-0009-01 55390-0009 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 8, 2000 June 30, 2013 No Longer Used
55390-0051-10 55390-0051 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 Aug. 31, 2013 No Longer Used
55390-0052-10 55390-0052 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 Aug. 31, 2014 No Longer Used
55390-0053-01 55390-0053 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 April 30, 2014 No Longer Used
55390-0054-01 55390-0054 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 8, 2000 Feb. 28, 2015 No Longer Used
55390-0818-10 55390-0818 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 28, 1996 Aug. 31, 2014 No Longer Used
55390-0824-01 55390-0824 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 28, 1996 April 30, 2014 No Longer Used
55390-0825-01 55390-0825 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote Sept. 28, 2001 May 31, 2013 No Longer Used
55390-0826-01 55390-0826 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote Sept. 28, 2001 June 30, 2013 No Longer Used
53270-0101-01 53270-0101 Levoleucovorin Fusilev Ancillary Therapy Chemoprotective Antidote Aug. 15, 2008 Feb. 24, 2010 No Longer Used
55390-0045-01 55390-0045 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent Feb. 23, 2004 July 31, 2012 No Longer Used
55390-0266-01 55390-0266 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent Jan. 9, 2004 July 31, 2012 No Longer Used
55390-0347-01 55390-0347 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent March 3, 2008 July 31, 2012 No Longer Used
63323-0733-10 63323-0733 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 5, 2001 In Use
63323-0733-11 63323-0733 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 5, 2001 In Use
23155-0240-41 23155-0240 Metoclopramide Hydrochloride Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Jan. 3, 2014 In Use
23155-0240-42 23155-0240 Metoclopramide Hydrochloride Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Jan. 3, 2014 In Use
23155-0240-43 23155-0240 Metoclopramide Hydrochloride Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Jan. 3, 2014 In Use
69639-0101-01 69639-0101 Netupitant and Palonosetron Akynzeo 300.0 mg/1, 0.5 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Oral Oct. 13, 2014 In Use
69639-0101-04 69639-0101 Netupitant and Palonosetron Akynzeo 300.0 mg/1, 0.5 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Oral Oct. 13, 2014 In Use
00054-0064-47 00054-0064 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 26, 2006 In Use
00338-1762-41 00338-1762 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Dec. 27, 2006 July 25, 2012 No Longer Used
00781-1879-13 00781-1879 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 June 25, 2007 No Longer Used
00781-3011-80 00781-3011 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous July 27, 2007 Oct. 31, 2011 No Longer Used
00781-5173-31 00781-5173 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 June 25, 2007 No Longer Used
00781-5192-31 00781-5192 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral June 25, 2007 June 25, 2007 No Longer Used
10019-0905-01 10019-0905 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov. 19, 2010 Sept. 30, 2013 No Longer Used
10019-0905-02 10019-0905 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov. 19, 2010 Sept. 30, 2013 No Longer Used
10019-0905-03 10019-0905 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov. 19, 2010 Sept. 30, 2013 No Longer Used
10019-0905-17 10019-0905 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov. 19, 2010 Sept. 30, 2013 No Longer Used
16590-0545-30 16590-0545 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 27, 2009 In Use
16729-0297-83 16729-0297 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Oct. 20, 2016 In Use
16729-0298-05 16729-0298 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Oct. 20, 2016 In Use

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