| Source HCPCS Code |
|
Target NDC Code |
C9175
Injection, treosulfan, 50 mg
|
⇄
|
59137-0335-00
GRAFAPEX 1 GRAM VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
C9175
Injection, treosulfan, 50 mg
|
⇄
|
59137-0335-01
GRAFAPEX 1 GRAM VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
C9175
Injection, treosulfan, 50 mg
|
⇄
|
59137-0365-00
GRAFAPEX 5 GRAM VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
C9175
Injection, treosulfan, 50 mg
|
⇄
|
59137-0365-01
GRAFAPEX 5 GRAM VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|