| Source HCPCS Code |
|
Target NDC Code |
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9466-01
TYZAVAN 1.25 GRAM/250 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/15/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
250 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9466-06
TYZAVAN FLEXIBLE BAG 1.25 GM/250 ML
|
| Detail Information |
| Relationship Start Date |
07/03/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
250 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9467-01
TYZAVAN 1.75 GRAM/350 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/15/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
350 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9467-06
TYZAVAN FLEXIBLE BAG 1.75 GM/350 ML
|
| Detail Information |
| Relationship Start Date |
07/03/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
350 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9468-06
TYZAVAN FLEXIBLE BAG 750 MG/150 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
150 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9468-12
TYZAVAN FLEXIBLE BAG 750 MG/150 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
150 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9469-01
TYZAVAN 1.5 GRAM/300 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/05/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9469-06
TYZAVAN 1.5 GRAM/300 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/05/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1800 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9470-01
TYZAVAN 2 GRAM/400 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/17/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9470-06
TYZAVAN 2 GRAM/400 ML BAG
|
| Detail Information |
| Relationship Start Date |
12/17/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
2400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9472-01
TYZAVAN 1 GRAM/200 ML BAG
|
| Detail Information |
| Relationship Start Date |
10/29/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
00143-9472-12
TYZAVAN 1 GRAM/200 ML BAG
|
| Detail Information |
| Relationship Start Date |
10/29/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
2400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0041-01
VANCOMYCIN 500 MG/100 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0041-03
VANCOMYCIN 500 MG/100 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0042-01
VANCOMYCIN 1 GRAM/200 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0042-03
VANCOMYCIN 1 GRAM/200 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0043-01
VANCOMYCIN 1.5 GRAM/300 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0043-02
VANCOMYCIN 1.5 GRAM/300 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0044-01
VANCOMYCIN 2 GRAM/400 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0044-02
VANCOMYCIN 2 GRAM/400 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0056-01
VANCOMYCIN 750 MG/150 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0056-03
VANCOMYCIN HCL (PREMIX) FLEXIBLE BAG 750 MG/150 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
150 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0057-01
VANCOMYCIN 1.25 GM/250 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0057-02
VANCOMYCIN HCL (PREMIX) FLEXIBLE BAG 1.25 GM/250 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
250 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0058-01
VANCOMYCIN 1.75 GM/350 ML BAG
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BAG |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J3375
INJECTION, VANCOMYCIN HYDROCHLORIDE (XELLIA), NOT THERAPEUTICALLY EQUIVALENT TO J3373, 10 MG
|
⇄
|
70594-0058-02
VANCOMYCIN HCL (PREMIX) FLEXIBLE BAG 1.75 GM/350 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
350 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9466-06
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9467-06
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9468-12
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9469-06
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9470-06
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
00143-9472-12
Tyzavan
|
| 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0041-03
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0042-03
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0043-02
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0044-02
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0056-03
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0057-02
Vancomycin 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 |
|
|
|
|
J3375
Inj vancomycin (xellia) 10mg
|
⇄
|
70594-0058-02
Vancomycin 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 |
|
|
|
|