| Source HCPCS Code |
|
Target NDC Code |
91321
SARSCOV2 VAC 25 MCG/.25ML IM
|
⇄
|
80777-0113-80
SPIKEVAX 2025-26 (6M-11Y) 25 mcg/0.25 mL single dose SYRG
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
91321
SARSCOV2 VAC 25 MCG/.25ML IM
|
⇄
|
80777-0113-87
SPIKEVAX 2025-26 (6M-11Y) 25 mcg/0.25 mL single dose SYRG
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
91321
SARSCOV2 VAC 25 MCG/.25ML IM
|
⇄
|
80777-0291-80
Moderna COVID-19 Vaccine (2024-2025) Preservative Free
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
91321
SARSCOV2 VAC 25 MCG/.25ML IM
|
⇄
|
80777-0291-81
Moderna COVID-19 Vaccine (2024-2025) Preservative Free
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|