| Source HCPCS Code |
|
Target NDC Code |
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0124-02
HUMIRA PEN 2X0.8ML;SINGLE DOSE 80 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0124-03
HUMIRA PEN STARTER PACK 80 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
3 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0124-04
HUMIRA PEN STARTER PACK PEDIATRIC 80 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
01/31/2025 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0243-02
HUMIRA CITRATE-FREE 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0554-02
HUMIRA 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0616-02
HUMIRA 20 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-0817-02
HUMIRA 10 MG/0.1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
Injection, adalimumab, 1 mg
|
⇄
|
00074-1539-03
HUMIRA(CF) PEN PS-UV-ADOL HS START 80 MG/0.8 ML-40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
KIT |
| Route Of Administration |
SQ |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-3799-02
HUMIRA PREFILLED SYRINGE 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
MR |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
00074-4339-02
HUMIRA SINGLE-USE PEN; 2X1ML,PREFILLED SYRINGE 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
MR |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
83457-0124-02
HUMIRA PEN SINGLE DOSE 80 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
83457-0243-02
HUMIRA 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
83457-0554-02
HUMIRA PEN 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
83457-0616-02
HUMIRA 20 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0139
INJECTION, ADALIMUMAB, 1 MG
|
⇄
|
83457-0817-02
HUMIRA 10 MG/0.1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|