| Source HCPCS Code |
|
Target NDC Code |
Q5144
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG
|
⇄
|
65219-0554-08
IDACIO PEN 1 TRAY W/2 PEN PER KIT 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
04/01/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5144
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG
|
⇄
|
65219-0554-28
IDACIO STARTER PACK-PLAQUE PSORIASIS 2 TRAYS W/4 PEN PER KIT 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
04/01/2025 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5144
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG
|
⇄
|
65219-0554-38
IDACIO STARTER PACK-CROHN'S & ULCERATIVE COLITIS 3 TRAYS W/6 PEN PER KIT 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
04/01/2025 |
| Number Of Items In Ndc Package |
3 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5144
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG
|
⇄
|
65219-0556-18
IDACIO PFS 1 TRAY W/2 SYNG PER KIT 40 MG/0.8 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
04/01/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5144
Injection, adalimumab-aacf (idacio), biosimilar, 1 mg
|
⇄
|
65219-0612-69
ADALIMUMAB-AACF(CF) PEN PSORIASIS-UV 40 MG/0.8 ML (4 PACK)
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
KIT |
| Route Of Administration |
SQ |
| Billing Units |
EA |
|
|
|
Q5144
Injection, adalimumab-aacf (idacio), biosimilar, 1 mg
|
⇄
|
65219-0612-89
ADALIMUMAB-AACF(CF) PEN CROHN'S-UC-HS 40 MG/0.8 ML (6 PACK)
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
KIT |
| Route Of Administration |
SQ |
| Billing Units |
EA |
|
|
|
Q5144
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG
|
⇄
|
65219-0612-99
ADALIMUMAB-AACF 1 TRAY W/2 PEN PER KIT 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 |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
Q5144
Injection, adalimumab-aacf (idacio), biosimilar, 1 mg
|
⇄
|
65219-0620-20
ADALIMUMAB-AACF(CF) 40 MG/0.8 ML SYRINGE
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
KIT |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|