| Source HCPCS Code |
|
Target NDC Code |
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0003-01
FLEBOGAMMA 5% (0.5 GM/VIAL,PF) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0003-02
FLEBOGAMMA 5% (2.5 GM/VIAL,PF) 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0003-03
FLEBOGAMMA 5% (5 GM/VIAL,PF) 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0003-04
FLEBOGAMMA 5% (10 GM/VIAL,PF) 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0004-01
FLEBOGAMMA (DIF,PF) 5 GM/100 ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0004-02
FLEBOGAMMA (DIF,PF) 5 GM/100 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0004-03
FLEBOGAMMA (DIF,PF) 5 GM/100 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0004-04
FLEBOGAMMA (DIF,PF) 5 GM/100 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 |
|
|
|
Q4091
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
|
⇄
|
61953-0004-05
FLEBOGAMMA (DIF,PF) 5 GM/100 ML
|
| Detail Information |
| Relationship Start Date |
7/1/2007 |
| Relationship End Date |
12/31/2007 |
| Number Of Items In Ndc Package |
400 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|