| Source HCPCS Code |
|
Target NDC Code |
J7205
Factor viii fc fusion recomb
|
⇄
|
64406-0808-01
ELOCTATE 4,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
04/15/2018 |
| Relationship End Date |
01/31/2021 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0801-01
ELOCTATE 250 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0802-01
ELOCTATE 500 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0803-01
ELOCTATE 750 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0804-01
ELOCTATE 1,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0805-01
ELOCTATE 1,500 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0806-01
ELOCTATE 2,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0807-01
ELOCTATE 3,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0808-01
ELOCTATE 4,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0809-01
ELOCTATE 5,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0810-01
ELOCTATE 6,000 UNIT NOMINAL
|
| Detail Information |
| Relationship Start Date |
05/29/2018 |
| 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 |
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0801-01
ELOCTATE
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0802-01
Eloctate
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0803-01
Eloctate
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0804-01
ELOCTATE
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0805-01
Eloctate
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0806-01
ELOCTATE
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0807-01
Eloctate
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0808-01
ELOCTATE
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0809-01
Eloctate
|
| 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 |
|
|
|
|
J7205
Factor viii fc fusion recomb
|
⇄
|
71104-0810-01
ELOCTATE
|
| 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 |
|
|
|
|