| Source NDC Code |
|
Target HCPCS Code |
44206-0451-01
HIZENTRA 1 GRAM/5 ML VIAL
|
⇄
|
90284
Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each
|
| Detail Information |
| Relationship Start Date |
04/15/2010 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
EA |
|
|
|
44206-0451-01
HIZENTRA (SINGLE-USE VIAL,PF) 20%
|
⇄
|
J1559
INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG
|
| Detail Information |
| Relationship Start Date |
01/01/2011 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
44206-0451-01
HIZENTRA (SINGLE-USE VIAL,PF) 20%
|
⇄
|
J7799
NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME
|
| Detail Information |
| Relationship Start Date |
4/1/2010 |
| Relationship End Date |
12/31/2010 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
44206-0451-01
Hizentra
|
⇄
|
J1559
Hizentra injection
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|