| Source HCPCS Code |
|
Target NDC Code |
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0370-82
CYLTEZO PFS 2X40MG/0.8ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0375-16
CYLTEZO PEN STARTER PACK CROHN'S,UC,HS 6X40MG/0.8ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
6 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0375-23
CYLTEZO PEN STARTER PACK PSORIASIS 4X40MG/0.8ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0375-97
CYLTEZO PEN 2X40MG/0.8ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0400-89
CYLTEZO PFS 2X10MG/0.2ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0405-80
CYLTEZO PFS 2X20MG/0.4ML 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0485-20
CYLTEZO PFS 2X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0495-40
CYLTEZO PEN STARTER PACK PSORIASIS/UVEITIS 4X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0495-50
CYLTEZO PEN 2X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0495-60
CYLTEZO PEN STARTER PACK CROHN'S,UC,HS 6X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
6 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0545-22
ADALIMUMAB-ADBM PEN 40MG/0.8ML DOSE 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0545-44
ADALIMUMAB-ADBM STARTER PACK PSORIASIS/UVEITIS 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0545-66
ADALIMUMAB-ADBM STARTER PACK CROHN'S, UC, HS 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
06/30/2025 |
| Number Of Items In Ndc Package |
6 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0555-80
ADALIMUMAB-ADBM 20MG/0.4ML DOSE 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0565-20
ADALIMUMAB-ADBM PFS 2X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0575-40
ADALIMUMAB-ADBM STARTER PACK PSORIASIS/UVEITIS 4X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0575-50
ADALIMUMAB-ADBM PEN 2X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0575-60
ADALIMUMAB-ADBM STARTER PACK CROHN'S, UC, HS 6X40MG/0.4ML 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
6 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0585-89
ADALIMUMAB-ADBM 10MG/0.2ML DOSE 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
00597-0595-20
ADALIMUMAB-ADBM 40MG/0.8ML DOSE 10 MG/0.2 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
82009-0144-22
ADALIMUMAB-ADBM PEN 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
82009-0146-22
ADALIMUMAB-ADBM PFS 40 MG/0.4 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
82009-0148-22
ADALIMUMAB-ADBM PEN 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5143
INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG
|
⇄
|
82009-0150-22
ADALIMUMAB-ADBM PFS 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|