| Source HCPCS Code |
|
Target NDC Code |
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
67467-0843-01
OCTAGAM (1GM/VIAL,S/D TREATED) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
67467-0843-02
OCTAGAM (2.5GM/VIAL,S/D TREATED) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
67467-0843-03
OCTAGAM (5GM/VIAL,S/D TREATED) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
67467-0843-04
OCTAGAM (10GM/VIAL,S/D TREATED) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
67467-0843-05
OCTAGAM (PF,SUCROSE-FREE) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
500 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
68209-0843-01
OCTAGAM (1GM/1VIAL,S/D TREATED) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
68209-0843-02
OCTAGAM (PF,SUCROSE-FREE) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
68209-0843-03
OCTAGAM (PF,SUCROSE-FREE) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4087
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
68209-0843-04
OCTAGAM (PF,SUCROSE-FREE) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|