| Source HCPCS Code |
|
Target NDC Code |
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0041-01
VANCOMYCIN 500 MG/100 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0041-03
VANCOMYCIN 500 MG/100 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0042-01
VANCOMYCIN 1 GRAM/200 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0042-03
VANCOMYCIN 1 GRAM/200 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0043-01
VANCOMYCIN 1.5 GRAM/300 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0043-02
VANCOMYCIN 1.5 GRAM/300 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0044-01
VANCOMYCIN 2 GRAM/400 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0044-02
VANCOMYCIN 2 GRAM/400 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0045-01
VANCOMYCIN 500 MG VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0045-02
VANCOMYCIN 500 MG VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
08/01/2023 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0046-01
VANCOMYCIN 1 GM VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
08/01/2023 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0046-02
VANCOMYCIN 1 GM VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
08/01/2023 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0047-01
VANCOMYCIN HCL 5 GM VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
08/01/2023 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0048-01
VANCOMYCIN HCL 10 GM VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
08/01/2023 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0056-01
VANCOMYCIN 750 MG/150 ML BA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
150 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
INJECTION, VANCOMYCIN HCL (XELLIA) NOT THERAPEUTICALLY EQUIVALENT TO J3370, 500 MG
|
⇄
|
70594-0056-03
VANCOMYCIN HCL (FLEXIBLE BAG) 750 MG/150 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
150 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
FC |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0057-01
VANCOMYCIN 1.25 GM/250 ML B
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
250 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
INJECTION, VANCOMYCIN HCL (XELLIA) NOT THERAPEUTICALLY EQUIVALENT TO J3370, 500 MG
|
⇄
|
70594-0057-02
VANCOMYCIN HCL (FLEXIBLE BAG) 1.25 GM/250 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
250 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
FC |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3372
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
|
⇄
|
70594-0058-01
VANCOMYCIN 1.75 GM/350 ML B
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
350 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3372
INJECTION, VANCOMYCIN HCL (XELLIA) NOT THERAPEUTICALLY EQUIVALENT TO J3370, 500 MG
|
⇄
|
70594-0058-02
VANCOMYCIN HCL (FLEXIBLE BAG) 1.75 GM/350 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
350 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
FC |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|