| Source HCPCS Code |
|
Target NDC Code |
J2315
INJECTION, NALTREXONE, DEPOT FORM, 1 MG
|
⇄
|
63459-0300-42
VIVITROL (W/DILUENT) 380 MG
|
| Detail Information |
| Relationship Start Date |
1/1/2007 |
| Relationship End Date |
5/1/2009 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IM |
| Billing Units |
EA |
|
|
|
J2315
Injection, naltrexone, depot form, 1 mg
|
⇄
|
65757-0300-01
VIVITROL 380 MG VIAL + DILUENT
|
| Detail Information |
| Relationship Start Date |
04/30/2009 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
KIT |
| Route Of Administration |
IM |
| Billing Units |
EA |
|
|
|
J2315
Injection, naltrexone, depot form, 1 mg
|
⇄
|
65757-0302-02
VIVITROL 380 MG VIAL
|
| Detail Information |
| Relationship Start Date |
10/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IJ |
| Billing Units |
EA |
|
|
|
J2315
Naltrexone, depot form
|
⇄
|
65757-0300-01
Vivitrol
|
| 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 |
|
|
|
|