| Source HCPCS Code |
|
Target NDC Code |
J7202
Factor ix idelvion inj
|
⇄
|
69911-0864-02
IDELVION 250 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
04/15/2018 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0865-02
IDELVION 500 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
04/15/2018 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0866-02
IDELVION 1,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
04/15/2018 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0867-02
IDELVION 2,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
04/15/2018 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0869-02
IDELVION 3,500 UNIT RANGE V
|
| Detail Information |
| Relationship Start Date |
08/28/2018 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0864-02
Idelvion
|
| 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 |
|
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0865-02
Idelvion
|
| 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 |
|
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0866-02
Idelvion
|
| 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 |
|
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0867-02
Idelvion
|
| 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 |
|
|
|
|
J7202
Factor ix idelvion inj
|
⇄
|
69911-0869-02
Idelvion
|
| 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 |
|
|
|
|