| Source HCPCS Code |
|
Target NDC Code |
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-01
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-02
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-03
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-05
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-10
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG
|
⇄
|
61476-0104-20
ALYGLO 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1552
Inj, alyglo, 500 mg
|
⇄
|
61476-0104-05
Alyglo
|
| 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 |
|
|
|
|
J1552
Inj, alyglo, 500 mg
|
⇄
|
61476-0104-10
Alyglo
|
| 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 |
|
|
|
|
J1552
Inj, alyglo, 500 mg
|
⇄
|
61476-0104-20
Alyglo
|
| 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 |
|
|
|
|