| Source HCPCS Code |
|
Target NDC Code |
S0013
Esketamine, nasal spray, 1 mg
|
⇄
|
50458-0028-00
SPRAVATO 28 MG NASAL SPRAY
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
SQUEEZ BTL |
| Route Of Administration |
NS |
| Billing Units |
EA |
|
|
|
S0013
Esketamine, nasal spray, 1 mg
|
⇄
|
50458-0028-02
SPRAVATO 56 MG DOSE PACK
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
SQUEEZ BTL |
| Route Of Administration |
NS |
| Billing Units |
EA |
|
|
|
S0013
Esketamine, nasal spray, 1 mg
|
⇄
|
50458-0028-03
SPRAVATO 84 MG DOSE PACK
|
| Detail Information |
| Relationship Start Date |
01/01/2025 |
| Relationship End Date |
12/31/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
SQUEEZ BTL |
| Route Of Administration |
NS |
| Billing Units |
EA |
|
|
|