| Source HCPCS Code |
|
Target NDC Code |
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
00703-9503-01
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
00703-9503-03
SMZ-TMP CONCENTRATE S.D.V. 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
00703-9514-01
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG/10 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
00703-9514-03
SMZ-TMP CONCENTRATE M.D.V. 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
00703-9514-81
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG/10 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
00703-9514-83
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG/10 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
00703-9514-91
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG/10 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
00703-9514-93
SULFAMETHOXAZOLE/TRIMETHOPRIM NOVAPLUS 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
00703-9526-01
SMZ-TMP M.D.V. 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
00703-9526-81
PREMIERPRO RX SULFAMETHOXAZOLE/TRIMETHOPRIM MDV 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
67457-0778-00
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
10/31/2025 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
67457-0778-05
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
10/31/2025 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
67457-0779-30
SULFAMETHOXAZOLE-TRIMETHOPRIM 2,400-480 MG/30 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
70069-0361-01
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
70069-0361-10
SULFAMETHOXAZOLE/TRIMETHOPRIM 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
|
⇄
|
70069-0362-01
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG/10 ML IV VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
70069-0362-10
SULFAMETHOXAZOLE/TRIMETHOPRIM 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG
|
⇄
|
70069-0363-01
SULFAMETHOXAZOLE/TRIMETHOPRIM 80 MG/1 ML-16 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
30 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
67457-0921-05
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
67457-0922-30
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
70069-0361-10
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
70069-0362-10
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
70069-0363-01
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9503-03
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9514-03
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9514-83
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9514-93
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9526-01
Sulfamethoxazole-Trimethoprim
|
| 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 |
|
|
|
|
J2865
Inj sulfameth/trim 5 mg/1 mg
|
⇄
|
00703-9526-81
Sulfamethoxazole/Trimethoprim
|
| 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 |
|
|
|
|