| Source NDC Code |
|
Target HCPCS Code |
59137-0365-00
GRAFAPEX 5 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 |
|
|
|
59137-0365-00
GRAFAPEX 5 GRAM VIAL
|
⇄
|
J0614
Injection, treosulfan, 50 mg
|
| Detail Information |
| Relationship Start Date |
10/01/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
59137-0365-00
GRAFAPEX 5 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 |
|
|
|