| Source HCPCS Code |
|
Target NDC Code |
J0875
Injection, dalbavancin, 5 mg
|
⇄
|
00480-3325-01
DALBAVANCIN HCL 500 MG VIAL
|
| Detail Information |
| Relationship Start Date |
10/31/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0875
Injection, dalbavancin, 5 mg
|
⇄
|
57970-0100-01
DALVANCE 500 MG VIAL
|
| 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 |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0875
Injection, dalbavancin, 5 mg
|
⇄
|
65219-0120-12
DALBAVANCIN HCL 500 MG VIAL
|
| Detail Information |
| Relationship Start Date |
11/10/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0875
Injection, dalbavancin, 5 mg
|
⇄
|
71288-0034-50
DALBAVANCIN HCL 500 MG VIAL
|
| Detail Information |
| Relationship Start Date |
12/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0875
Injection, dalbavancin
|
⇄
|
57970-0100-01
Dalvance
|
| 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 |
|
|
|
|
J0875
Injection, dalbavancin
|
⇄
|
65219-0120-12
Dalvavancin
|
| 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 |
|
|
|
|
J0875
Injection, dalbavancin
|
⇄
|
71288-0034-50
Dalbavancin
|
| 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 |
|
|
|
|
J0875
Injection, dalbavancin
|
⇄
|
00480-3325-01
Dalbavacin HCl
|
| 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 |
|
|
|
|