| Source NDC Code |
|
Target HCPCS Code |
59137-0335-01
GRAFAPEX 1 GRAM VIAL
|
⇄
|
C9175
Injection, treosulfan, 50 mg
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
59137-0335-01
GRAFAPEX SDV,LYOPHILIZED 1 GM
|
⇄
|
J0614
INJECTION, TREOSULFAN, 50 MG
|
| Detail Information |
| Relationship Start Date |
10/01/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
59137-0335-01
GRAFAPEX 1 GRAM VIAL
|
⇄
|
J9999
Not otherwise classified, antineoplastic drugs
|
| Detail Information |
| Relationship Start Date |
07/01/2025 |
| Relationship End Date |
09/30/2025 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
59137-0335-01
Grafapex
|
⇄
|
J0614
Inj, treosulfan, 50 mg
|
| 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 |
|
|
|
|