| Source HCPCS Code |
|
Target NDC Code |
J0751
EMTRICITABINE 200MG AND TENOFOVIR ALAFENAMIDE 25MG, ORAL, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV)
|
⇄
|
61958-2002-01
DESCOVY (FILM COATED) 200 MG-25 MG
|
| Detail Information |
| Relationship Start Date |
01/02/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
PO |
| Billing Units |
EA |
|
|
|
J0751
EMTRICITABINE 200MG AND TENOFOVIR ALAFENAMIDE 25MG, ORAL, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV)
|
⇄
|
61958-2002-02
DESCOVY (10X3,FILM COATED) 200 MG-25 MG
|
| Detail Information |
| Relationship Start Date |
01/02/2024 |
| Relationship End Date |
02/11/2025 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
PO |
| Billing Units |
EA |
|
|
|
J0751
EMTRICITABINE 200MG AND TENOFOVIR ALAFENAMIDE 25MG, ORAL, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV)
|
⇄
|
61958-2005-01
DESCOVY (FILM COATED) 120 MG-15 MG
|
| Detail Information |
| Relationship Start Date |
01/02/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
PO |
| Billing Units |
EA |
|
|
|
J0751
Hiv prep, ftc/taf 200/25mg
|
⇄
|
61958-2002-01
Descovy
|
| 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 |
|
|
|
|
J0751
Hiv prep, ftc/taf 200/25mg
|
⇄
|
61958-2002-02
Descovy
|
| 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 |
|
|
|
|