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OBSOLETE DATE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11/01/2020 00781344820 SYMJEPI J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299 00409724161 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299 00409724160 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299 00409492134 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299 00409492120 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299 67457085930 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085820 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085730 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085620 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085502 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085500 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085404 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 67457085400 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065190 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065189 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065130 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065123 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065121 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065120 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065104 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 63323065102 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 55150019330 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 55150019301 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 55150019220 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 55150019201 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 25021030168 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 25021030167 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 17478095302 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 17478054430 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 17478054420 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 17478054225 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 17478054202 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 00703877701 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 00703877601 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 00409193202 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 00409193201 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299 00074937402 HUMIRA J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074433974 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074433907 HUMIRA PEN PSOR-UVEITS-ADOL HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074433906 HUMIRA PEN CROHN'S-UC-HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074433902 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074433901 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074379902 HUMIRA J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074254003 HUMIRA(CF) PEDIATRIC CROHN'S J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074153903 HUMIRA(CF) PEN PSOR-UV-ADOL HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074081702 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074061602 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074055471 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074055402 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074024302 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074012474 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074012403 HUMIRA(CF) PEN CROHN'S-UC-HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074012402 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 00074006702 HUMIRA(CF) PEDIATRIC CROHN'S J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299 66220020730 ACETADOTE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 63323096344 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 63323096341 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 63323096330 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 63323096321 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 55150025930 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 25021081230 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 17478066030 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 00574081530 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 00574081500 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 00574080530 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 00574080500 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299 00003281811 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299 00003281411 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299 00003218851 ORENCIA CLICKJECT J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299 00003218713 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299 71773005012 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299 71773005005 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299 71773005001 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299 71715000102 NUZYRA J0121 INJ., OMADACYCLINE, 1 MG 11/1/2019 12/31/2299 71715000101 NUZYRA J0121 INJ., OMADACYCLINE, 1 MG 11/1/2019 12/31/2299 NDC CODE NDC DESCRIPTION PROCEDURE COD PROCEDURE DESCRIPTION EFFECTIVE DATE END DATE Cabinet for Health and Family Services Department for Medicaid Services NDC - Procedure Code Crosswalk

NDC - Procedure Code Crosswalk - Kentucky

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Page 1: NDC - Procedure Code Crosswalk - Kentucky

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11/01/202000781344820 SYMJEPI J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

00409724161 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

00409724160 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

00409492134 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

00409492120 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

67457085930 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085820 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085730 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085620 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085502 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085500 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085404 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

67457085400 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065190 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065189 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065130 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065123 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065121 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065120 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065104 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

63323065102 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

55150019330 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

55150019301 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

55150019220 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

55150019201 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

25021030168 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

25021030167 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

17478095302 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

17478054430 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

17478054420 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

17478054225 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

17478054202 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

00703877701 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

00703877601 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

00409193202 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

00409193201 ADENOSINE J0153 ADENOSINE INJ 1MG 11/1/2019 12/31/2299

00074937402 HUMIRA J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074433974 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074433907 HUMIRA PEN PSOR-UVEITS-ADOL HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074433906 HUMIRA PEN CROHN'S-UC-HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074433902 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074433901 HUMIRA PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074379902 HUMIRA J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074254003 HUMIRA(CF) PEDIATRIC CROHN'S J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074153903 HUMIRA(CF) PEN PSOR-UV-ADOL HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074081702 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074061602 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074055471 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074055402 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074024302 HUMIRA(CF) J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074012474 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074012403 HUMIRA(CF) PEN CROHN'S-UC-HS J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074012402 HUMIRA(CF) PEN J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

00074006702 HUMIRA(CF) PEDIATRIC CROHN'S J0135 ADALIMUMAB INJECTION 11/1/2019 12/31/2299

66220020730 ACETADOTE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

63323096344 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

63323096341 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

63323096330 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

63323096321 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

55150025930 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

25021081230 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

17478066030 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

00574081530 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

00574081500 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

00574080530 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

00574080500 ACETYLCYSTEINE J0132 ACETYLCYSTEINE INJECTION 11/1/2019 12/31/2299

00003281811 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299

00003281411 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299

00003218851 ORENCIA CLICKJECT J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299

00003218713 ORENCIA J0129 ABATACEPT INJECTION 11/1/2019 12/31/2299

71773005012 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299

71773005005 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299

71773005001 XERAVA J0122 INJ., ERAVACYCLINE, 1 MG 11/1/2019 12/31/2299

71715000102 NUZYRA J0121 INJ., OMADACYCLINE, 1 MG 11/1/2019 12/31/2299

71715000101 NUZYRA J0121 INJ., OMADACYCLINE, 1 MG 11/1/2019 12/31/2299

NDC CODE NDC DESCRIPTIONPROCEDURE

CODPROCEDURE DESCRIPTION EFFECTIVE DATE END DATE

Cabinet for Health and Family Services

Department for Medicaid Services

NDC - Procedure Code Crosswalk

Page 2: NDC - Procedure Code Crosswalk - Kentucky

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000143987525 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

00143987501 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

00409738501 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

00409592216 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

00409592201 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

00409592116 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

00409592101 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

00074490918 AMINOPHYLLINE J0280 AMINOPHYLLIN 250 MG INJ 11/1/2019 12/31/2299

63323081522 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

63323081521 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

63323081504 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

63323081502 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

25021017304 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

25021017302 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

23155029042 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

23155029041 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

23155029032 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

23155029031 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00703904003 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00703904001 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00703903203 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00703903201 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00641616710 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00641616701 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00641616610 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00641616601 AMIKACIN SULFATE J0278 AMIKACIN SULFATE INJECTION 11/1/2019 12/31/2299

00037814006 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037814001 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037813006 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037813001 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037812006 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037812001 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037811006 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

00037811001 MUSE J0275 ALPROSTADIL URETHRAL SUPPOS 11/1/2019 12/31/2299

52244004006 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

52244004002 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

52244002006 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

52244002002 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

52244001006 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

52244001002 EDEX J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00703150102 ALPROSTADIL J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00703150101 ALPROSTADIL J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009768604 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009768601 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009765002 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009518201 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009518110 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009518101 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009370108 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009370105 CAVERJECT J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009316906 PROSTIN VR PEDIATRIC J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00009316901 PROSTIN VR PEDIATRIC J0270 ALPROSTADIL FOR INJECTION 11/1/2019 12/31/2299

00944288402 GLASSIA J0257 GLASSIA INJECTION 11/1/2019 12/31/2299

00944288401 GLASSIA J0257 GLASSIA INJECTION 11/1/2019 12/31/2299

13533070511 PROLASTIN C J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

13533070501 PROLASTIN C J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

13533070310 PROLASTIN C J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

13533070011 PROLASTIN C J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

13533070002 PROLASTIN C J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

00944281501 ARALAST NP J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

00944281401 ARALAST NP J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

00944280404 ARALAST NP J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

00944280303 ARALAST NP J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

00053720102 ZEMAIRA J0256 ALPHA 1 PROTEINASE INHIBITOR 11/1/2019 12/31/2299

71336100101 GIVLAARI J0223 INJ GIVOSIRAN 0.5 MG 7/1/2020 12/31/2299

71336100001 ONPATTRO J0222 INJ., PATISIRAN, 0.1 MG 11/1/2019 12/31/2299

58468016002 LUMIZYME J0221 LUMIZYME INJECTION 11/1/2019 12/31/2299

58468016001 LUMIZYME J0221 LUMIZYME INJECTION 11/1/2019 12/31/2299

58468016002 LUMIZYME J0220 ALGLUCOSIDASE ALFA INJECTION 11/1/2019 12/31/2299

58468016001 LUMIZYME J0220 ALGLUCOSIDASE ALFA INJECTION 11/1/2019 12/31/2299

58468035701 CAMPATH J0202 INJECTION, ALEMTUZUMAB 11/1/2019 12/31/2299

58468020001 LEMTRADA J0202 INJECTION, ALEMTUZUMAB 11/1/2019 12/31/2299

47426020101 CINVANTI J0185 INJ., APREPITANT, 1 MG 11/1/2019 12/31/2299

58468004101 FABRAZYME J0180 AGALSIDASE BETA INJECTION 11/1/2019 12/31/2299

58468004001 FABRAZYME J0180 AGALSIDASE BETA INJECTION 11/1/2019 12/31/2299

00078082761 BEOVU J0179 INJ, BROLUCIZUMAB-DBLL, 1 MG 11/1/2019 12/31/2299

61755000555 EYLEA J0178 AFLIBERCEPT INJECTION 11/1/2019 12/31/2299

61755000502 EYLEA J0178 AFLIBERCEPT INJECTION 11/1/2019 12/31/2299

61755000501 EYLEA J0178 AFLIBERCEPT INJECTION 11/1/2019 12/31/2299

76329906000 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

76329331601 EPINEPHRINE J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

42023016899 ADRENALIN J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

42023016889 ADRENALIN J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

42023016801 ADRENALIN J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

42023015925 ADRENALIN J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

42023015901 ADRENALIN J0171 ADRENALIN EPINEPHRINE INJECT 11/1/2019 12/31/2299

Page 3: NDC - Procedure Code Crosswalk - Kentucky

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09/21/2020

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065219001810 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219001801 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219001610 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219001601 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219001410 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219001401 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

63323070800 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

63323040400 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

55150011599 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

55150011420 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

55150011310 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

55150011210 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

55150011110 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

44567010410 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

44567010401 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

44567010310 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

44567010210 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

44567010110 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

25021013720 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

25021013610 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

25021013510 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

25021013410 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781941392 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781941315 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781941292 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781941215 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940995 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940946 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940895 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940880 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940795 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940778 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940495 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940485 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940295 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940278 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940195 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781940178 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781927395 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781927380 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781926195 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781926185 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781925095 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781925078 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781924295 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781924278 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781341392 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781341315 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781341292 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781341215 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340995 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340946 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340895 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340880 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340795 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340778 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340495 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340485 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340295 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340278 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340095 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00781340078 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372610 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372601 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372511 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372501 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372010 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409372001 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409371910 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409371901 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409371810 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00409371801 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

00469305130 AMBISOME J0289 AMPHOTERICIN B LIPOSOME INJ 11/1/2019 12/31/2299

57665010141 ABELCET J0287 AMPHOTERICIN B LIPID COMPLEX 11/1/2019 12/31/2299

39822105505 AMPHOTERICIN B J0285 AMPHOTERICIN B 11/1/2019 12/31/2299

67457015399 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

67457015318 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

67457015309 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

67457015303 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

67457015300 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

63323061609 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

63323061603 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

55150018218 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

55150018109 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

55150018003 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

25021030266 AMIODARONE HCL J0282 AMIODARONE HCL 11/1/2019 12/31/2299

Page 4: NDC - Procedure Code Crosswalk - Kentucky

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071288000775 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

71288000631 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

71288000630 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

71288000521 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

71288000520 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

67457064910 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

67457034910 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

67457034810 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

66794020815 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

66794020741 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

66794020702 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

66794020641 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

66794020602 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

63323037062 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

63323036920 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

55150011899 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

55150011720 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

55150011620 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

44567021201 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

44567021110 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

44567021010 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021018899 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021018730 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021018620 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021014499 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021014330 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

25021014220 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00781303446 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00781303395 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00781303370 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00781303295 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00781303270 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00641611801 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00641611710 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00641611701 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00641611610 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00641611601 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409299803 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409298723 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409298703 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409268921 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409268911 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409268901 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00409268715 AMPICILLIN-SULBACTAM J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00049002428 UNASYN J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00049001483 UNASYN J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00049001481 UNASYN J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00049001383 UNASYN J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

00049001381 UNASYN J0295 AMPICILLIN SULBACTAM 1.5 GM 11/1/2019 12/31/2299

71045001002 ZEMDRI J0291 INJ., PLAZOMICIN, 5 MG 11/1/2019 12/31/2299

71045001001 ZEMDRI J0291 INJ., PLAZOMICIN, 5 MG 11/1/2019 12/31/2299

69097082096 ZEMDRI J0291 INJ., PLAZOMICIN, 5 MG 11/1/2019 12/31/2299

69097082037 ZEMDRI J0291 INJ., PLAZOMICIN, 5 MG 11/1/2019 12/31/2299

72572001710 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

72572001701 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

72572001610 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

72572001601 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011899 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011541 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011526 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011441 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011415 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011341 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011315 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011241 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

70860011215 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457040410 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035325 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035310 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035210 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035202 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035110 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035101 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035050 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

67457035010 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022415 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022341 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022302 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022241 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022202 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022141 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022102 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022041 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

66794022002 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219002023 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

65219002003 AMPICILLIN SODIUM J0290 AMPICILLIN 500 MG INJ 11/1/2019 12/31/2299

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000409163010 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

70860012566 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

70860012541 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

70860010041 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

70860010010 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

70436001982 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

67457086050 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

67457086000 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

63323039841 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

63323039814 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

63323039810 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

63323039801 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

62756051244 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

62756051240 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

60505607604 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

55150017410 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

50111079478 AZITHROMYCIN J0456 AZITHROMYCIN 11/1/2019 12/31/2299

00409014421 AZITHROMYCIN J0456 AZITHROMYCIN 1/1/2020 12/31/2299

00409014411 AZITHROMYCIN J0456 AZITHROMYCIN 1/1/2020 12/31/2299

00069315084 ZITHROMAX J0456 AZITHROMYCIN 11/1/2019 12/31/2299

00069315083 ZITHROMAX J0456 AZITHROMYCIN 11/1/2019 12/31/2299

00069040010 ZITHROMAX J0456 AZITHROMYCIN 11/1/2019 12/31/2299

00069040001 ZITHROMAX J0456 AZITHROMYCIN 11/1/2019 12/31/2299

59148007292 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148007280 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148004580 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148001991 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148001971 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148001970 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148001871 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

59148001870 ABILIFY MAINTENA J0401 INJ ARIPIPRAZOLE EXT REL 1MG 11/1/2019 12/31/2299

27505000405 APOKYN J0364 APOMORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

27505000401 APOKYN J0364 APOMORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

72572026525 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

72572026501 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

67457029101 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

67457029100 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

63323061455 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

63323061421 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

63323061416 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

63323061401 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

63323061400 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

39822050004 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

39822050001 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

17478093415 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

00517090125 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

00517090101 HYDRALAZINE HCL J0360 HYDRALAZINE HCL INJECTION 11/1/2019 12/31/2299

00049011628 ERAXIS (WATER DILUENT) J0348 ANIDULAFUNGIN INJECTION 11/1/2019 12/31/2299

00049011428 ERAXIS (WATER DILUENT) J0348 ANIDULAFUNGIN INJECTION 11/1/2019 12/31/2299

75834015125 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

75834015102 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

72572075010 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

72572075001 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70710137702 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70710137701 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70121158105 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70121158101 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70069030125 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70069030110 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

70069030101 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

69918070026 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

69918070025 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

69918070010 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

69918070002 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

69918070001 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

68001044860 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

68001044828 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

54879003725 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

54879003710 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

51991096499 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

51991096425 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

43598066625 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

43598066611 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

14789010407 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

14789010405 SUCCINYLCHOLINE CHLORIDE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00781905395 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00781905370 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00781341195 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00781341170 ANECTINE J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00409662961 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00409662935 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00409662925 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00409662912 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00409662902 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00074806515 QUELICIN J0330 SUCCINYCHOLINE CHLORIDE INJ 11/1/2019 12/31/2299

00187430305 AMYTAL SODIUM J0300 AMOBARBITAL 125 MG INJ 11/1/2019 12/31/2299

Page 6: NDC - Procedure Code Crosswalk - Kentucky

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000228315603 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

00228315303 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

00054017713 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

00054017613 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

52440010014 PROBUPHINE J0570 BUPRENORPHINE IMPLANT 74.2MG 11/1/2019 12/31/2299

68135081102 BRINEURA J0567 INJ., CERLIPONASE ALFA 1 MG 11/1/2019 12/31/2299

68135050000 BRINEURA J0567 INJ., CERLIPONASE ALFA 1 MG 11/1/2019 12/31/2299

00006302501 ZINPLAVA J0565 INJ, BEZLOTOXUMAB, 10 MG 11/1/2019 12/31/2299

00006302500 ZINPLAVA J0565 INJ, BEZLOTOXUMAB, 10 MG 11/1/2019 12/31/2299

60793070210 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793070204 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793070110 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793070102 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793070010 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793070001 BICILLIN L-A J0561 PENICILLIN G BENZATHINE INJ 11/1/2019 12/31/2299

60793060210 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

60793060202 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

60793060110 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

60793060102 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

60793060010 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

60793060002 BICILLIN C-R J0558 PENG BENZATHINE/PROCAINE INJ 11/1/2019 12/31/2299

00310183085 FASENRA PEN J0517 INJ., BENRALIZUMAB, 1 MG 11/1/2019 12/31/2299

00310183030 FASENRA PEN J0517 INJ., BENRALIZUMAB, 1 MG 11/1/2019 12/31/2299

00310173085 FASENRA J0517 INJ., BENRALIZUMAB, 1 MG 11/1/2019 12/31/2299

00310173030 FASENRA J0517 INJ., BENRALIZUMAB, 1 MG 11/1/2019 12/31/2299

00143972905 BENZTROPINE MESYLATE J0515 INJ BENZTROPINE MESYLATE 11/1/2019 12/31/2299

00143972901 BENZTROPINE MESYLATE J0515 INJ BENZTROPINE MESYLATE 11/1/2019 12/31/2299

72266012705 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

72266012701 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

63323084221 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

63323084202 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

58914008052 BENTYL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

31722096332 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

31722096331 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

24201058510 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

24201058501 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

17478001502 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

14789001007 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

14789001002 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

00641617310 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

00641617301 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

00517198005 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

00517198001 DICYCLOMINE HCL J0500 DICYCLOMINE INJECTION 11/1/2019 12/31/2299

49401010201 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

49401010101 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

49401008847 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

49401008842 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

49401008835 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

49401008801 BENLYSTA J0490 BELIMUMAB INJECTION 11/1/2019 12/31/2299

00003037113 NULOJIX J0485 BELATACEPT INJECTION 11/1/2019 12/31/2299

00078039361 SIMULECT J0480 BASILIXIMAB 11/1/2019 12/31/2299

00078033184 SIMULECT J0480 BASILIXIMAB 11/1/2019 12/31/2299

70257056255 LIORESAL INTRATHECAL J0476 BACLOFEN INTRATHECAL TRIAL 11/1/2019 12/31/2299

70257056211 LIORESAL INTRATHECAL J0476 BACLOFEN INTRATHECAL TRIAL 11/1/2019 12/31/2299

66794015101 GABLOFEN J0476 BACLOFEN INTRATHECAL TRIAL 11/1/2019 12/31/2299

70257056320 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056302 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056301 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056105 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056102 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056020 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056002 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

70257056001 LIORESAL INTRATHECAL J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

67457056420 BACLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

67457056320 BACLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

67457056220 BACLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015702 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015701 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015602 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015601 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015502 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

66794015501 GABLOFEN J0475 BACLOFEN 10 MG INJECTION 11/1/2019 12/31/2299

76329333901 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

63323058020 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

63323058003 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00641600610 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00641600601 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00517101025 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00517040125 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409963005 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409962905 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409491134 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409491111 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409491034 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409491011 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

00409163015 ATROPINE SULFATE J0461 ATROPINE SULFATE INJECTION 11/1/2019 12/31/2299

Page 7: NDC - Procedure Code Crosswalk - Kentucky

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02/13/2020

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043598058101 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

12496121203 SUBOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

12496121201 SUBOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

00781724964 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

00781724906 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

00378876893 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

00378876816 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

65162041503 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

62756097083 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

62175045832 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

59385001630 BUNAVAIL J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

59385001601 BUNAVAIL J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

54123095730 ZUBSOLV J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

52427069811 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

52427069803 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

50383028793 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

50268014515 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

50268014511 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

47781035711 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

47781035703 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

43598058230 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

43598058201 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

12496120803 SUBOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

12496120801 SUBOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00904701006 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00781723864 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00781723806 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00406802003 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00378876793 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00378876716 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00228315573 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00228315567 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00228315503 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

00054018913 BUPRENORPHINE-NALOXONE J0574 BUPREN/NAL 6.1 TO 10MG BUPRE 11/1/2019 12/31/2299

59385001430 BUNAVAIL J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

59385001401 BUNAVAIL J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

54123092930 ZUBSOLV J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

52427069411 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

52427069403 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

47781035611 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

47781035603 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

43598058030 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

43598058001 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

12496120403 SUBOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

12496120401 SUBOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

00781722764 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

00781722706 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

00378876693 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

00378876616 BUPRENORPHINE-NALOXONE J0573 BUPREN/NAL 3.1 TO 6MG BUPREN 11/1/2019 12/31/2299

65162041603 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

62756096983 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

62175045232 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

59385001230 BUNAVAIL J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

59385001201 BUNAVAIL J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

54123091430 ZUBSOLV J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

54123090730 ZUBSOLV J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

52427069211 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

52427069203 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

50383029493 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

50268014415 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

50268014411 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

47781035511 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

47781035503 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

43598057930 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

43598057901 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

12496120203 SUBOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

12496120201 SUBOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00781721664 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00781721606 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00406800503 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00406192303 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00378876593 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00378876516 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00228315473 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00228315403 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

00054018813 BUPRENORPHINE-NALOXONE J0572 BUPREN/NAL UP TO 3MG BUPRENO 11/1/2019 12/31/2299

62756046083 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

62756045983 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

60687049221 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

60687049211 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

60687048121 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

60687048111 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

50383093093 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

50383092493 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

42858050203 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

42858050103 BUPRENORPHINE HCL J0571 BUPRENORPHINE ORAL 1MG 11/1/2019 12/31/2299

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000409162301 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00143986710 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00143986410 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

72606055902 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

72606055901 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

72485021008 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

72485021001 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

71288011611 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

71288011610 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

70860021641 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

70860021610 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

70121124401 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

67457089308 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

67457089300 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

65219016010 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

65219016001 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

60505617708 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

60505617700 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

59148007091 BUSULFEX J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

59148004791 BUSULFEX J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

59148004790 BUSULFEX J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

45963064077 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

45963064057 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

25021024110 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

16729035192 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

16729035103 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

00517092008 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

00517092001 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

00409111210 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

00409111201 BUSULFAN J0594 BUSULFAN INJECTION 11/1/2019 12/31/2299

47783064401 TAKHZYRO J0593 INJ., LANADELUMAB-FLYO, 1 MG 11/1/2019 12/31/2299

42023017905 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

42023017901 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

12496075705 BUPRENEX J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409201232 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409201203 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00143924605 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00143924601 BUPRENORPHINE HCL J0592 BUPRENORPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

46783016001 XEOMIN J0588 INCOBOTULINUMTOXIN A 11/1/2019 12/31/2299

00259162001 XEOMIN J0588 INCOBOTULINUMTOXIN A 11/1/2019 12/31/2299

00259161001 XEOMIN J0588 INCOBOTULINUMTOXIN A 11/1/2019 12/31/2299

00259160501 XEOMIN J0588 INCOBOTULINUMTOXIN A 11/1/2019 12/31/2299

10454071210 MYOBLOC J0587 INJ, RIMABOTULINUMTOXINB 11/1/2019 12/31/2299

10454071110 MYOBLOC J0587 INJ, RIMABOTULINUMTOXINB 11/1/2019 12/31/2299

10454071010 MYOBLOC J0587 INJ, RIMABOTULINUMTOXINB 11/1/2019 12/31/2299

15054053006 DYSPORT J0586 ABOBOTULINUMTOXINA 11/1/2019 12/31/2299

15054050001 DYSPORT J0586 ABOBOTULINUMTOXINA 11/1/2019 12/31/2299

00299596230 DYSPORT J0586 ABOBOTULINUMTOXINA 11/1/2019 12/31/2299

00023392102 BOTOX J0585 INJECTION,ONABOTULINUMTOXINA 11/1/2019 12/31/2299

00023114501 BOTOX J0585 INJECTION,ONABOTULINUMTOXINA 11/1/2019 12/31/2299

69794030401 CRYSVITA J0584 INJECTION, BUROSUMAB-TWZA 1M 11/1/2019 12/31/2299

69794020301 CRYSVITA J0584 INJECTION, BUROSUMAB-TWZA 1M 11/1/2019 12/31/2299

69794010201 CRYSVITA J0584 INJECTION, BUROSUMAB-TWZA 1M 11/1/2019 12/31/2299

72572003510 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

72572003501 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

70860040351 BIVALIRUDIN J0583 BIVALIRUDIN 1/1/2020 12/31/2299

70860040350 BIVALIRUDIN J0583 BIVALIRUDIN 1/1/2020 12/31/2299

70860040241 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

70860040210 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

67457025610 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

67457025600 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

65293000101 ANGIOMAX J0583 BIVALIRUDIN 11/1/2019 12/31/2299

63323056241 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

63323056215 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

63323056210 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

60505610104 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

55150021010 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

55111065237 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

55111065207 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

16729027567 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

16729027503 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00781915895 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00781915894 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00781344795 ANGIOMAX J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00781315895 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00781315894 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00409830020 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00409830010 BIVALIRUDIN J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00338957612 BIVALIRUDIN-0.9% NACL J0583 BIVALIRUDIN 11/1/2019 12/31/2299

00338957224 BIVALIRUDIN-0.9% NACL J0583 BIVALIRUDIN 11/1/2019 12/31/2299

54123011430 ZUBSOLV J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

52427071211 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

52427071203 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

47781035811 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

47781035803 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

43598058130 BUPRENORPHINE-NALOXONE J0575 BUPREN/NAL OVER 10MG BUPRENO 11/1/2019 12/31/2299

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02/21/2020

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02/21/2020

02/21/2020

02/21/2020

063323036001 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031166 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031161 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031159 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031150 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031119 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323031110 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

44567062124 CALCIUM GLUCONATE-NACL J0610 CALCIUM GLUCONATE INJECTION 1/1/2020 12/31/2299

44567062101 CALCIUM GLUCONATE-NACL J0610 CALCIUM GLUCONATE INJECTION 1/1/2020 12/31/2299

00074118401 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

55513074210 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

55513074201 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

55513074110 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

55513074101 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

55513074010 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

55513074001 PARSABIV J0606 INJ, ETELCALCETIDE, 0.1 MG 11/1/2019 12/31/2299

76282067630 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

76282067530 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

76282067430 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

71093015401 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

71093015301 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

71093015201 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

70436000904 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

70436000804 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

70436000704 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

69097041202 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

69097041102 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

69097041002 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

67877050530 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

67877050430 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

67877050330 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

65862083330 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

65862083230 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

65862083130 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

64380088504 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

64380088404 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

64380088304 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

60687052521 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

60687052511 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

55513007530 SENSIPAR J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

55513007430 SENSIPAR J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

55513007330 SENSIPAR J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

47335060083 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

47335038083 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

47335037983 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

43598036930 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

43598036830 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

43598036730 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

42543096304 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

42543096204 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

42543096104 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

31722010530 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

31722010430 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

31722010330 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044215 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044210 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044115 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044110 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044015 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16729044010 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16714008001 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16714007901 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

16714007801 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

00904706704 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

00378619793 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

00378619693 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

00378619593 CINACALCET HCL J0604 CINACALCET, ESRD ON DIALYSIS 11/1/2019 12/31/2299

63833082902 HAEGARDA J0599 INJ., HAEGARDA 10 UNITS 11/1/2019 12/31/2299

63833082802 HAEGARDA J0599 INJ., HAEGARDA 10 UNITS 11/1/2019 12/31/2299

42227008105 CINRYZE J0598 C-1 ESTERASE, CINRYZE 11/1/2019 12/31/2299

42227008101 CINRYZE J0598 C-1 ESTERASE, CINRYZE 11/1/2019 12/31/2299

63833083501 BERINERT J0597 C-1 ESTERASE, BERINERT 11/1/2019 12/31/2299

63833082502 BERINERT J0597 C-1 ESTERASE, BERINERT 11/1/2019 12/31/2299

71274035002 RUCONEST J0596 INJECTION, RUCONEST 11/1/2019 12/31/2299

71274035001 RUCONEST J0596 INJECTION, RUCONEST 11/1/2019 12/31/2299

68012035002 RUCONEST J0596 INJECTION, RUCONEST 11/1/2019 12/31/2299

68012035001 RUCONEST J0596 INJECTION, RUCONEST 11/1/2019 12/31/2299

61703031845 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

61703031745 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162642 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162621 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162610 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162609 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162602 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162601 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

00409162321 BUTORPHANOL TARTRATE J0595 BUTORPHANOL TARTRATE 1 MG 11/1/2019 12/31/2299

Page 10: NDC - Procedure Code Crosswalk - Kentucky

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063323026001 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

00409204750 CARBOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

00409106720 CARBOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

00409104130 CARBOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

00409103850 CARBOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

00409103630 CARBOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

68152011401 KHAPZORY J0642 INJECTION, KHAPZORY, 0.5 MG 11/1/2019 12/31/2299

68152011201 KHAPZORY J0642 INJECTION, KHAPZORY, 0.5 MG 11/1/2019 12/31/2299

72266012101 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

72266012001 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

71288010518 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

71288010410 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

70121157201 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

70121109901 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

50742049525 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

50742049417 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

45963076257 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

43598077311 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

43598077111 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

16714091501 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

16714089001 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

00781320194 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

00143955801 LEVOLEUCOVORIN CALCIUM J0641 INJ LEVOLEUCOVORIN NOS 0.5MG 11/1/2019 12/31/2299

68001041838 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001041737 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001041636 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028639 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028638 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028540 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028537 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028536 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028529 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028528 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

68001028522 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

67457053035 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

67457052920 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

67457052810 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

63323071100 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

63323071059 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

63323071050 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

63323063150 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

63323063110 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021082850 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081667 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081630 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081567 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081530 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081467 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081430 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081366 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

25021081310 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00703514591 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00703514501 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00703514001 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00143955501 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00143955401 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00143955301 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00143955201 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

00143936801 LEUCOVORIN CALCIUM J0640 LEUCOVORIN CALCIUM INJECTION 11/1/2019 12/31/2299

72611070201 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

72611070001 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

72266010701 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

72266010601 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

70860010710 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

70860010610 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

67457083270 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

67457083150 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

63323035810 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

63323035801 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

63323035610 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

63323035601 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

47781061407 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

47781061307 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00781342394 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00781342301 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00781342194 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00781342101 CASPOFUNGIN ACETATE J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00006382310 CANCIDAS J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

00006382210 CANCIDAS J0637 CASPOFUNGIN ACETATE 11/1/2019 12/31/2299

63323073101 CALCITRIOL J0636 INJ CALCITRIOL PER 0.1 MCG 11/1/2019 12/31/2299

17478093101 CALCITRIOL J0636 INJ CALCITRIOL PER 0.1 MCG 11/1/2019 12/31/2299

63323036061 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323036059 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323036019 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323036005 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

63323036003 CALCIUM GLUCONATE J0610 CALCIUM GLUCONATE INJECTION 11/1/2019 12/31/2299

Page 11: NDC - Procedure Code Crosswalk - Kentucky

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063323034020 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

63323032621 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

63323032620 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614704 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614700 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614604 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614600 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614504 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614500 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614404 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

60505614400 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

44567024110 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

44567024010 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

25021012267 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

25021012250 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

25021012166 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

25021012120 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409973510 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409973501 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409956610 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409956601 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409022011 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409022001 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021911 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021901 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021811 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021801 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021711 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00409021701 MAXIPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00338130148 CEFEPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00338130141 CEFEPIME J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00264319511 CEFEPIME-DEXTROSE J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

00264319311 CEFEPIME-DEXTROSE J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

72000012006 XENLETA J0691 INJ LEFAMULIN 1 MG 7/1/2020 12/31/2299

72000012001 XENLETA J0691 INJ LEFAMULIN 1 MG 7/1/2020 12/31/2299

63323044961 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

63323023861 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

63323023710 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

63323023610 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505614304 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505614300 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505614205 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505614200 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505074905 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

60505074901 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

44567070810 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

44567070725 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

44567070625 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

44567012025 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010299 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010269 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010167 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010110 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010066 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

25021010010 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345295 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345246 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345196 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345170 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345095 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00781345070 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409258511 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409258501 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409080611 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409080601 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409080511 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00409080501 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00338350341 CEFAZOLIN SODIUM-DEXTROSE J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00264310511 CEFAZOLIN SODIUM-DEXTROSE J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00264310311 CEFAZOLIN SODIUM-DEXTROSE J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143998391 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143998303 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143992490 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143992390 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143926225 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143926201 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143926110 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00143926101 CEFAZOLIN SODIUM J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

00007313116 ANCEF J0690 CEFAZOLIN SODIUM INJECTION 11/1/2019 12/31/2299

63323029657 POLOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323029427 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323029401 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323029337 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323029301 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323028357 POLOCAINE J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

63323026037 POLOCAINE-MPF J0670 INJ MEPIVACAINE HCL/10 ML 11/1/2019 12/31/2299

Page 12: NDC - Procedure Code Crosswalk - Kentucky

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025021010899 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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25021010667 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

25021010610 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

25021010566 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

25021010510 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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00781320995 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320990 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320895 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320885 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320795 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320785 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320695 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00781320685 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733821 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733820 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733811 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733801 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733721 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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00409733513 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733503 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

00409733420 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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00338500341 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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00264315511 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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00143985725 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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67919003001 ZERBAXA J0695 INJ CEFTOLOZANE TAZOBACTAM 11/1/2019 12/31/2299

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63323034366 CEFOXITIN J0694 CEFOXITIN SODIUM INJECTION 11/1/2019 12/31/2299

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60505075905 CEFOXITIN J0694 CEFOXITIN SODIUM INJECTION 11/1/2019 12/31/2299

60505075901 CEFOXITIN J0694 CEFOXITIN SODIUM INJECTION 11/1/2019 12/31/2299

44567024710 CEFOXITIN J0694 CEFOXITIN SODIUM INJECTION 11/1/2019 12/31/2299

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71288000920 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

71288000815 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

66794021041 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

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66794020902 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

63323034021 CEFEPIME HCL J0692 CEFEPIME HCL FOR INJECTION 11/1/2019 12/31/2299

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00517002010 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

51754506001 BETAMETHASONE SOD PHOS-ACETATE J0702 BETAMETHASONE ACET&SOD PHOSP 11/1/2019 12/31/2299

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00085432001 CELESTONE J0702 BETAMETHASONE ACET&SOD PHOSP 11/1/2019 12/31/2299

64679094802 CEFOTAXIME SODIUM J0698 CEFOTAXIME SODIUM INJECTION 11/1/2019 12/31/2299

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00039002450 CLAFORAN J0698 CEFOTAXIME SODIUM INJECTION 11/1/2019 12/31/2299

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00039002349 CLAFORAN J0698 CEFOTAXIME SODIUM INJECTION 11/1/2019 12/31/2299

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00039001801 CLAFORAN J0698 CEFOTAXIME SODIUM INJECTION 11/1/2019 12/31/2299

63323035445 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

63323035245 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

25021012059 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

25021011810 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

00338204348 ZINACEF J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

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00143997922 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

00143956901 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

00143956825 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

00143956801 CEFUROXIME SODIUM J0697 STERILE CEFUROXIME INJECTION 11/1/2019 12/31/2299

72572006225 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

72572006201 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

72572006125 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

72572006101 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

68180064410 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

68180064401 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

68180063310 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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66794021515 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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63323034610 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

63323034510 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

63323034410 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505615204 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505615201 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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60505615101 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505615005 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505614904 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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60505614800 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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60505075303 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075204 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075203 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075104 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075101 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075100 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075004 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075001 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

60505075000 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

44567070301 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

44567070225 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

44567070125 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

44567070025 CEFTRIAXONE J0696 CEFTRIAXONE SODIUM INJECTION 11/1/2019 12/31/2299

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07/02/2020

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036000029824 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

36000029724 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

36000000924 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

36000000824 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

25021011487 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00409477723 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00409477721 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00409477711 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00409477702 CIPROFLOXACIN-D5W J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00085176303 CIPRO I.V. J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

00085176101 CIPRO I.V. J0744 CIPROFLOXACIN IV 11/1/2019 12/31/2299

63323034994 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323034993 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323034925 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323034920 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323032294 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323032293 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323032225 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

63323032220 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00409350821 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00409350801 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00409350721 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00409350701 IMIPENEM-CILASTATIN SODIUM J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00006351659 PRIMAXIN J0743 CILASTATIN SODIUM INJECTION 11/1/2019 12/31/2299

00006385602 RECARBRIO J0742 INJ IMIP 4 CILAS 4 RELEB 2MG 7/1/2020 12/31/2299

00006385601 RECARBRIO J0742 INJ IMIP 4 CILAS 4 RELEB 2MG 7/1/2020 12/31/2299

67457021005 CIDOFOVIR J0740 CIDOFOVIR INJECTION 11/1/2019 12/31/2299

23155021631 CIDOFOVIR J0740 CIDOFOVIR INJECTION 11/1/2019 12/31/2299

67457021810 DURACLON J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

63323042710 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

63323040510 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

39822201001 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

39822200001 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

00143972401 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

00143972301 CLONIDINE HCL J0735 CLONIDINE HYDROCHLORIDE 11/1/2019 12/31/2299

63323003011 CHORIONIC GONADOTROPIN J0725 CHORIONIC GONADOTROPIN/1000U 11/1/2019 12/31/2299

55566150201 NOVAREL J0725 CHORIONIC GONADOTROPIN/1000U 11/1/2019 12/31/2299

55566150101 NOVAREL J0725 CHORIONIC GONADOTROPIN/1000U 11/1/2019 12/31/2299

00052031510 PREGNYL J0725 CHORIONIC GONADOTROPIN/1000U 11/1/2019 12/31/2299

50474071081 CIMZIA J0717 CERTOLIZUMAB PEGOL INJ 1MG 11/1/2019 12/31/2299

50474071079 CIMZIA J0717 CERTOLIZUMAB PEGOL INJ 1MG 11/1/2019 12/31/2299

50474070062 CIMZIA J0717 CERTOLIZUMAB PEGOL INJ 1MG 11/1/2019 12/31/2299

00456270010 AVYCAZ J0714 CEFTAZIDIME AND AVIBACTAM 11/1/2019 12/31/2299

00456270001 AVYCAZ J0714 CEFTAZIDIME AND AVIBACTAM 11/1/2019 12/31/2299

52565010710 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

52565010701 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

52565010610 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

52565010601 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

52565010510 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

52565010501 FORTAZ J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

44567023706 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

44567023610 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

44567023525 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012999 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012969 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012867 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012850 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012766 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

25021012720 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00781317780 CEFTAZIDIME J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409509314 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409509311 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409509216 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409509211 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409508611 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409508413 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409508411 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409508216 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00409508211 TAZICEF J0713 INJ CEFTAZIDIME PER 500 MG 11/1/2019 12/31/2299

00456060010 TEFLARO J0712 CEFTAROLINE FOSAMIL INJ 11/1/2019 12/31/2299

00456060001 TEFLARO J0712 CEFTAROLINE FOSAMIL INJ 11/1/2019 12/31/2299

00456040010 TEFLARO J0712 CEFTAROLINE FOSAMIL INJ 11/1/2019 12/31/2299

00456040001 TEFLARO J0712 CEFTAROLINE FOSAMIL INJ 11/1/2019 12/31/2299

72485010410 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

72485010401 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

63323040704 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

63323040703 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

55150018703 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

51754050201 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

51754050001 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

47335028940 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

47335028927 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

47335028926 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

42571024469 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

25021060103 CAFFEINE CITRATE J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

00641616410 CAFCIT J0706 CAFFEINE CITRATE INJECTION 11/1/2019 12/31/2299

Page 15: NDC - Procedure Code Crosswalk - Kentucky

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055513000401 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000304 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000301 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000204 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000201 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

72572010201 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

72572010001 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

71839010801 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

71839010701 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

71288001810 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

70594005301 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

70594003401 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

69097080737 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

68001037668 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

67919001202 CUBICIN RF J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

67919001201 CUBICIN RF J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

67919001101 CUBICIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

67457081350 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

63323087115 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

63323058515 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

63323037119 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

63323037110 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

43598041311 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017967 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017966 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017916 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017915 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017416 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

25021017415 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

16729043505 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

16729043445 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

16729043405 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

16714089201 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

00781329570 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

00703012501 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

00409593301 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

00409275701 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

00143937801 DAPTOMYCIN J0878 DAPTOMYCIN INJECTION 11/1/2019 12/31/2299

57970010001 DALVANCE J0875 INJECTION, DALBAVANCIN 11/1/2019 12/31/2299

44206053290 CYTOGAM J0850 CYTOMEGALOVIRUS IMM IV /VIAL 11/1/2019 12/31/2299

44206053211 CYTOGAM J0850 CYTOMEGALOVIRUS IMM IV /VIAL 11/1/2019 12/31/2299

66621079002 ANAVIP J0841 INJ CROTALIDAE IM F(AB')2 EQ 11/1/2019 12/31/2299

66621079001 ANAVIP J0841 INJ CROTALIDAE IM F(AB')2 EQ 11/1/2019 12/31/2299

67457022702 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

67457022700 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

00781344095 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

00781344071 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

00781305295 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

00781305271 COSYNTROPIN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

00548590000 CORTROSYN J0834 INJ., COSYNTROPIN, 0.25 MG 11/1/2019 12/31/2299

63004871002 ACTHAR J0800 CORTICOTROPIN INJECTION 11/1/2019 12/31/2299

63004871001 ACTHAR J0800 CORTICOTROPIN INJECTION 11/1/2019 12/31/2299

55566030201 ACTHREL J0795 CORTICORELIN OVINE TRIFLUTAL 11/1/2019 12/31/2299

00078088361 ADAKVEO J0791 INJ CRIZANLIZUMAB-TMCA 5MG 7/1/2020 12/31/2299

72572058025 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

72572058001 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

70860077841 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

70860077810 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

70860077802 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

67457064099 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

67457064002 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

67457064000 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155052341 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155052331 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155049742 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155049731 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155029442 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155029441 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

23155029431 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

14789070007 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

14789070002 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

00641613525 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

00641613501 PROCHLORPERAZINE EDISYLATE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

00007335216 COMPAZINE J0780 PROCHLORPERAZINE INJECTION 11/1/2019 12/31/2299

66887000301 XIAFLEX J0775 COLLAGENASE, CLOST HIST INJ 11/1/2019 12/31/2299

70594002304 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

70594002301 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

63323039306 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

42023013106 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

42023013101 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

42023010706 COLY-MYCIN M PARENTERAL J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

42023010701 COLY-MYCIN M PARENTERAL J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

39822061502 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

39822061501 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

25021015910 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

23155019331 COLISTIMETHATE J0770 COLISTIMETHATE SODIUM INJ 11/1/2019 12/31/2299

Page 16: NDC - Procedure Code Crosswalk - Kentucky

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055513014801 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513014410 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513014401 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513012610 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513012601 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

67457021202 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

63323052603 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

55150024110 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

55150024101 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

42367020384 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

42367020307 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

42367020284 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

42367020207 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

42023018201 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00781331495 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00781331491 ARGATROBAN-SODIUM CHLORIDE J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00781328554 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00781328512 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00409114001 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00143967401 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00143955901 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00143937701 ARGATROBAN-0.9% NACL J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00143928801 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

00078093061 ARGATROBAN J0884 ARGATROBAN ESRD DIALYSIS 1MG 11/1/2019 12/31/2299

67457021202 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

63323052603 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

55150024110 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

55150024101 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

42367020384 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

42367020307 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

42367020284 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

42367020207 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

42023018201 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00781331495 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00781331491 ARGATROBAN-SODIUM CHLORIDE J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00781328554 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00781328512 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00409114001 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00143967401 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00143955901 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00143937701 ARGATROBAN-0.9% NACL J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00143928801 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

00078093061 ARGATROBAN J0883 ARGATROBAN NONESRD USE 1MG 11/1/2019 12/31/2299

55513011101 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513011001 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513009804 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513009801 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513005704 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513005701 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513003201 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002801 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002704 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002701 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002504 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002501 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002304 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002301 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002104 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513002101 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000601 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000504 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000501 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000404 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000401 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000304 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000301 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000204 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513000201 ARANESP J0882 DARBEPOETIN ALFA, ESRD USE 11/1/2019 12/31/2299

55513011101 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513011001 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513005704 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513005701 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513003201 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002801 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002704 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002701 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002504 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002501 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002304 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002301 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002104 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513002101 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000601 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000504 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000501 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513000404 ARANESP J0881 DARBEPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

Page 17: NDC - Procedure Code Crosswalk - Kentucky

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000781313271 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00781313195 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00781313171 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703006301 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703005104 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703005101 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703004501 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703004301 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703003104 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00703003101 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009347523 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009347522 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009347503 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009347501 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009307323 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009307322 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009307303 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009307301 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009030612 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009030602 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009028052 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009028051 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009028003 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009028002 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009027401 DEPO-MEDROL J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00009027101 DEPO-ESTRADIOL J1000 DEPO-ESTRADIOL CYPIONATE INJ 11/1/2019 12/31/2299

55513073001 XGEVA J0897 DENOSUMAB INJECTION 11/1/2019 12/31/2299

55513071001 PROLIA J0897 DENOSUMAB INJECTION 11/1/2019 12/31/2299

59572077501 REBLOZYL J0896 INJ LUSPATERCEPT-AAMT 0.25MG 7/1/2020 12/31/2299

59572071101 REBLOZYL J0896 INJ LUSPATERCEPT-AAMT 0.25MG 7/1/2020 12/31/2299

63323059930 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

63323059710 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

52609450506 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

52609450501 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

52609450406 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

52609450401 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

47781062407 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

00409233725 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

00409233610 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

00409233601 DEFEROXAMINE MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

00078046791 DESFERAL MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

00078046761 DESFERAL MESYLATE J0895 DEFEROXAMINE MESYLATE INJ 11/1/2019 12/31/2299

75834019001 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

72603010701 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

72205003601 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

72205003101 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

70121164401 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

69097028537 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

68001042237 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

67457031625 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

63323082520 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

59148004670 DACOGEN J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

55111055610 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

50742043001 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

47335036141 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

47335036140 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

43598042737 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

43598034837 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

25021023120 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

16729022405 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

16714092801 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

16714074901 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

00781329680 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

00781313980 DECITABINE J0894 DECITABINE INJECTION 11/1/2019 12/31/2299

59676034001 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676034000 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676032004 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676032000 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676031204 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676031200 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676031002 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676031001 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676031000 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030401 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030400 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030301 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030300 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030201 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

59676030200 PROCRIT J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513047810 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513047801 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513028310 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513028301 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513026710 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513026701 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

55513014810 EPOGEN J0885 EPOETIN ALFA, NON-ESRD 11/1/2019 12/31/2299

Page 18: NDC - Procedure Code Crosswalk - Kentucky

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016714098102 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

16714098101 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00703680104 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00703680101 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548571100 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548570100 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548541025 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548541000 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548540025 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00548540000 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00009737611 DEPO-PROVERA J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00009470913 DEPO-SUBQ PROVERA 104 J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00009074635 DEPO-PROVERA J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00009074630 DEPO-PROVERA J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

00009062601 DEPO-PROVERA J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

70121157405 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

70121157401 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

70121157305 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

70121157301 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313775 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313670 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313295 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313271 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313195 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00781313171 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703006301 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703005104 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703005101 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703004501 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703004301 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703003104 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00703003101 METHYLPREDNISOLONE ACETATE J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009347523 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009347522 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009347503 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009347501 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009307323 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009307322 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009307303 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009307301 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009030612 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009030602 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009028052 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009028051 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009028003 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009028002 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

00009027401 DEPO-MEDROL J1040 METHYLPREDNISOLONE 80 MG INJ 11/1/2019 12/31/2299

70121157405 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

70121157401 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

70121157305 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

70121157301 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313775 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313670 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313295 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313271 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313195 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00781313171 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703006301 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703005104 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703005101 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703004501 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703004301 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703003104 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00703003101 METHYLPREDNISOLONE ACETATE J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00009347523 DEPO-MEDROL J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

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00009028003 DEPO-MEDROL J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00009028002 DEPO-MEDROL J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

00009027401 DEPO-MEDROL J1030 METHYLPREDNISOLONE 40 MG INJ 11/1/2019 12/31/2299

70121157405 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

70121157401 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

70121157305 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

70121157301 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00781313775 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00781313670 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

00781313295 METHYLPREDNISOLONE ACETATE J1020 METHYLPREDNISOLONE 20 MG INJ 11/1/2019 12/31/2299

Page 19: NDC - Procedure Code Crosswalk - Kentucky

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067457042312 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

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67457042254 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

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67457042000 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

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67457041805 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

67457041800 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323051610 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323050616 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323050601 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016530 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016526 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016516 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016505 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016503 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016502 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

63323016501 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

55150030510 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

55150030501 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

55150023930 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

55150023805 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

55150023701 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641614625 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641614601 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641614525 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641614501 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641036725 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00641036721 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00517493025 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00517490525 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

00517490125 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

62225060099 OMIDRIA J1097 PHENYLEP KETOROLAC OPTH SOLN 11/1/2019 12/31/2299

62225060004 OMIDRIA J1097 PHENYLEP KETOROLAC OPTH SOLN 11/1/2019 12/31/2299

62225060000 OMIDRIA J1097 PHENYLEP KETOROLAC OPTH SOLN 11/1/2019 12/31/2299

70382020488 DEXTENZA J1096 DEXAMETHA OPTH INSERT 0.1 MG 11/1/2019 12/31/2299

70382020410 DEXTENZA J1096 DEXAMETHA OPTH INSERT 0.1 MG 11/1/2019 12/31/2299

70382020401 DEXTENZA J1096 DEXAMETHA OPTH INSERT 0.1 MG 11/1/2019 12/31/2299

71879000101 DEXYCU J1095 INJECTION, DEXAMETHASONE 9% 11/1/2019 12/31/2299

69097080237 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

69097080232 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

69097053737 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

69097053731 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

69097053637 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

62756001740 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

62756001640 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

62756001540 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

52536062510 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

52536062501 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00781307471 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00781307470 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00781307370 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00591412879 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00574082710 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00574082701 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00574082010 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00574082001 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00517183001 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00409656222 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00409656220 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00409656202 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00409656201 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00409655701 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00143972601 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

00143965901 TESTOSTERONE CYPIONATE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

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00009034702 DEPO-TESTOSTERONE J1071 INJ TESTOSTERONE CYPIONATE 11/1/2019 12/31/2299

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67457088799 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

67457088701 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

67457088700 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

62756009045 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

62756009040 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

59762453802 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

59762453702 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

59762453701 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

50102059140 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

16714099901 MEDROXYPROGESTERONE ACETATE J1050 MEDROXYPROGESTERONE ACETATE 11/1/2019 12/31/2299

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063323085303 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085225 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085203 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085150 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085115 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085110 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085107 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085103 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

17478054050 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

17478054005 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

17478054001 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00703011303 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00703011301 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00703011003 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00703011001 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00703001801 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00641615125 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00641615101 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00641234141 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00641234139 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409345917 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409345907 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409336511 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409336501 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409335611 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409335601 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409263450 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409263425 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409263410 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409263405 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409263401 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409255211 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409255201 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409254011 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409254001 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409131210 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409131209 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128337 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128317 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128310 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128309 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128305 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00409128304 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

00641613925 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641613901 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641613825 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641613801 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641255545 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641255541 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641049325 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00641049321 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00409184432 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

00409131702 PHENYTOIN SODIUM J1165 PHENYTOIN SODIUM INJECTION 11/1/2019 12/31/2299

70515026310 LANOXIN PEDIATRIC J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

70515026210 LANOXIN PEDIATRIC J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

70515026110 LANOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

70515026010 LANOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00781305995 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00781305972 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00641618425 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00641618401 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00641141035 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00641141031 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

00409216931 DIGOXIN J1160 DIGOXIN INJECTION 11/1/2019 12/31/2299

66490004101 D.H.E.45 J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

61990041102 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

61990041101 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

61990041100 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

00574085105 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

00574085010 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

00574085005 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

00143927310 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

00143927301 DIHYDROERGOTAMINE MESYLATE J1110 INJ DIHYDROERGOTAMINE MESYLT 11/1/2019 12/31/2299

76045010910 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

72572012225 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

72572012201 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

72572012025 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

72572012001 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

70069002510 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

70069002501 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

70069002125 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

70069002101 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

67457048430 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

67457048400 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

67457048310 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

67457048300 DEXAMETHASONE SODIUM PHOSPHATE J1100 DEXAMETHASONE SODIUM PHOS 11/1/2019 12/31/2299

Page 21: NDC - Procedure Code Crosswalk - Kentucky

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10/20/2020

03/19/2020

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000409780922 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409780911 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409582011 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409582001 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409426501 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409414202 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00338100902 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00338100703 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00338100702 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00338100503 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00338100502 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00143925425 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00143925401 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00143925225 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00143925201 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00074910518 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00074581916 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00074426618 DOPAMINE HCL ADDITIVE SYRINGE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00074414203 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00074414103 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

10019018120 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409372432 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409372411 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234732 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234731 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234634 DOBUTAMINE HCL IN DEXTROSE J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234632 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234631 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234488 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234468 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234462 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234402 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409234401 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409202560 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409202554 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00409202520 DOBUTAMINE HCL J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00338107702 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00338107502 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00338107302 DOBUTAMINE HCL-D5W J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00338107103 DOBUTAMINE HCL IN DEXTROSE J1250 INJ DOBUTAMINE HCL/250 MG 11/1/2019 12/31/2299

00641256944 DIPYRIDAMOLE J1245 DIPYRIDAMOLE INJECTION 11/1/2019 12/31/2299

00641256941 DIPYRIDAMOLE J1245 DIPYRIDAMOLE INJECTION 11/1/2019 12/31/2299

00409204302 DIPYRIDAMOLE J1245 DIPYRIDAMOLE INJECTION 11/1/2019 12/31/2299

63323036601 DIMENHYDRINATE J1240 DIMENHYDRINATE INJECTION 11/1/2019 12/31/2299

67457017750 RIMSO-50 J1212 DIMETHYL SULFOXIDE 50% 50 ML 11/1/2019 12/31/2299

70720010025 QUZYTTIR J1201 INJ. CETIRIZINE HCL 0.5MG 7/1/2020 12/31/2299

70720010010 QUZYTTIR J1201 INJ. CETIRIZINE HCL 0.5MG 7/1/2020 12/31/2299

70720010001 QUZYTTIR J1201 INJ. CETIRIZINE HCL 0.5MG 7/1/2020 12/31/2299

76045010210 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

72485010125 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

72485010101 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

67457012410 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

63323066441 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

63323066416 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

63323066401 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

63323066400 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

00641037625 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

00641037621 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

00409229031 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

00409229003 DIPHENHYDRAMINE HCL J1200 DIPHENHYDRAMINE HCL INJECTIO 11/1/2019 12/31/2299

72611071601 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

72266010101 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

67457020950 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

67457020850 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

67457020725 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

67457020425 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

51991094298 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

47781057807 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

00143924801 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

00143924701 DEXRAZOXANE J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

00013872789 ZINECARD J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

00013871762 ZINECARD J1190 DEXRAZOXANE HCL INJECTION 11/1/2019 12/31/2299

76045012111 DILAUDID J1170 HYDROMORPHONE INJECTION 4/1/2020 12/31/2299

76045012101 DILAUDID J1170 HYDROMORPHONE INJECTION 4/1/2020 12/31/2299

76045001110 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045001011 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045001010 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045001001 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045001000 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045000911 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045000910 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045000901 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

76045000900 DILAUDID J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085410 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085403 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

63323085325 HYDROMORPHONE HCL J1170 HYDROMORPHONE INJECTION 11/1/2019 12/31/2299

Page 22: NDC - Procedure Code Crosswalk - Kentucky

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12/29/2020

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042023011001 DELESTROGEN J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00781303075 ESTRADIOL VALERATE J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00574087205 ESTRADIOL VALERATE J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00574087005 ESTRADIOL VALERATE J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00517044001 ESTRADIOL VALERATE J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00517042001 ESTRADIOL VALERATE J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

00409648211 ERYTHROCIN LACTOBIONATE J1364 ERYTHRO LACTOBIONATE /500 MG 11/1/2019 12/31/2299

00409648201 ERYTHROCIN LACTOBIONATE J1364 ERYTHRO LACTOBIONATE /500 MG 11/1/2019 12/31/2299

00409647654 ERYTHROCIN LACTOBIONATE J1364 ERYTHRO LACTOBIONATE /500 MG 11/1/2019 12/31/2299

00409647644 ERYTHROCIN LACTOBIONATE J1364 ERYTHRO LACTOBIONATE /500 MG 11/1/2019 12/31/2299

68001040831 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

68001040829 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

63323082320 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

63323082301 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

60505619604 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

60505619600 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

55150028220 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

55150028209 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

44567082010 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

44567082001 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

42023022189 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

42023022185 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

42023022110 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

42023022101 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

00409351022 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

00409351021 ERTAPENEM J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

00006384371 INVANZ J1335 ERTAPENEM INJECTION 11/1/2019 12/31/2299

72078002610 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70436016380 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70436016280 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70436002780 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70436002680 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70121100301 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

70121100201 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

67457063110 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

67457063010 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

67457062910 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

55150022099 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

55150021910 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

55150021899 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

25021040910 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

25021040851 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

17478090390 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

17478090210 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

16729026038 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

16729026003 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00703117901 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00338955810 EPTIFIBATIDE J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00085117702 INTEGRILIN J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00085117701 INTEGRILIN J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00085113602 INTEGRILIN J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

00085113601 INTEGRILIN J1327 EPTIFIBATIDE INJECTION 11/1/2019 12/31/2299

66215040301 VELETRI J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

66215040201 VELETRI J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

00703199501 EPOPROSTENOL SODIUM J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

00703198501 EPOPROSTENOL SODIUM J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

00173051900 FLOLAN J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

00173051700 FLOLAN J1325 EPOPROSTENOL INJECTION 11/1/2019 12/31/2299

68135010001 VIMIZIM J1322 ELOSULFASE ALFA, INJECTION 11/1/2019 12/31/2299

25682002201 ULTOMIRIS J1303 INJ., RAVULIZUMAB-CWVZ 10 MG 11/1/2019 12/31/2299

70510217102 RADICAVA J1301 INJECTION, EDARAVONE, 1 MG 11/1/2019 12/31/2299

70510217101 RADICAVA J1301 INJECTION, EDARAVONE, 1 MG 11/1/2019 12/31/2299

25682000101 SOLIRIS J1300 ECULIZUMAB INJECTION 11/1/2019 12/31/2299

47783010101 KALBITOR J1290 ECALLANTIDE INJECTION 11/1/2019 12/31/2299

71288080203 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

71288080202 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

70121140805 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

70121140801 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

68180071852 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

68180071801 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012701 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012700 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012601 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012600 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012301 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

58468012300 HECTOROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

43598085050 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

43598085011 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

00409133011 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

00409133001 DOXERCALCIFEROL J1270 INJECTION, DOXERCALCIFEROL 11/1/2019 12/31/2299

00409910421 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409910420 DOPAMINE HCL J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409781022 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409781011 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409780931 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

00409780924 DOPAMINE HCL IN 5% DEXTROSE J1265 DOPAMINE INJECTION 11/1/2019 12/31/2299

Page 23: NDC - Procedure Code Crosswalk - Kentucky

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05/05/2020

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0

000338000801 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00143938401 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306105 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306104 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306103 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306102 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306101 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00006306100 EMEND J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

70710147801 FOMEPIZOLE J1451 FOMEPIZOLE, 15 MG 11/1/2019 12/31/2299

67457021102 FOMEPIZOLE J1451 FOMEPIZOLE, 15 MG 11/1/2019 12/31/2299

00517071001 FOMEPIZOLE J1451 FOMEPIZOLE, 15 MG 11/1/2019 12/31/2299

70655008810 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

70655008806 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

70655000210 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

70655000206 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

69784000306 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021018487 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021018482 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021018467 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021018466 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021011387 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

25021011382 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00703102930 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00703102030 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468833 FLUCONAZOLE IN SALINE J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468829 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468827 FLUCONAZOLE IN SALINE J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468822 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468818 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468816 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00409468812 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00338604648 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

00338604537 FLUCONAZOLE-NACL J1450 FLUCONAZOLE 11/1/2019 12/31/2299

63459092059 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459092053 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091859 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091853 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091236 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091218 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091217 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091215 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091212 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091211 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091201 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091036 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091018 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091017 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091015 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091012 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091011 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

63459091001 GRANIX J1447 INJ TBO FILGRASTIM 1 MICROG 11/1/2019 12/31/2299

57278031502 TRIFERIC J1444 FE PYRO CIT POW 0.1 MG IRON 11/1/2019 12/31/2299

57278031501 TRIFERIC J1444 FE PYRO CIT POW 0.1 MG IRON 11/1/2019 12/31/2299

57278031402 TRIFERIC J1443 INJ FERRIC PYROPHOSPHATE CIT 11/1/2019 12/31/2299

57278031401 TRIFERIC J1443 INJ FERRIC PYROPHOSPHATE CIT 11/1/2019 12/31/2299

55513092491 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513092410 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513092401 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513054610 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513054601 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513053010 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513053001 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513020991 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513020910 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

55513020901 NEUPOGEN J1442 INJ FILGRASTIM EXCL BIOSIMIL 11/1/2019 12/31/2299

00517065001 INJECTAFER J1439 INJ FERRIC CARBOXYMALTOS 1MG 11/1/2019 12/31/2299

58406045504 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406045501 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406044504 ENBREL SURECLICK J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406044501 ENBREL SURECLICK J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406043504 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406043501 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406042541 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406042534 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406003204 ENBREL SURECLICK J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406003201 ENBREL SURECLICK J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406002104 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406002101 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406001004 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

58406001001 ENBREL J1438 ETANERCEPT INJECTION 11/1/2019 12/31/2299

73594931001 MONOFERRIC J1437 INJ. FE DERISOMALTOSE 10 MG 10/1/2020 12/31/2299

60923046502 VYONDYS-53 J1429 INJ GOLODIRSEN 10 MG 7/1/2020 12/31/2299

60923036302 EXONDYS-51 J1428 INJ, ETEPLIRSEN, 10 MG 11/1/2019 12/31/2299

60923028410 EXONDYS-51 J1428 INJ, ETEPLIRSEN, 10 MG 11/1/2019 12/31/2299

42023011201 DELESTROGEN J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

42023011101 DELESTROGEN J1380 ESTRADIOL VALERATE 10 MG INJ 11/1/2019 12/31/2299

Page 24: NDC - Procedure Code Crosswalk - Kentucky

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013533080015 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080013 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080012 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

44206045896 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045824 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045795 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045722 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045694 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045621 HIZENTRA J1559 HIZENTRA INJECTION 4/1/2020 12/31/2299

44206045593 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045510 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045492 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045404 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045291 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045202 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045190 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

44206045101 HIZENTRA J1559 HIZENTRA INJECTION 11/1/2019 12/31/2299

13533081051 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081050 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081021 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081020 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081011 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081010 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081006 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

13533081005 XEMBIFY J1558 INJ. XEMBIFY, 100 MG 7/1/2020 12/31/2299

64208823507 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823506 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823505 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823503 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823502 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823501 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823408 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823407 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823406 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823404 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823403 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

64208823402 GAMMAPLEX J1557 GAMMAPLEX INJECTION 11/1/2019 12/31/2299

69800650202 BIVIGAM J1556 INJ, IMM GLOB BIVIGAM, 500MG 11/1/2019 12/31/2299

69800650201 BIVIGAM J1556 INJ, IMM GLOB BIVIGAM, 500MG 11/1/2019 12/31/2299

59730650201 BIVIGAM J1556 INJ, IMM GLOB BIVIGAM, 500MG 11/1/2019 12/31/2299

00944285008 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285007 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285006 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285005 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285004 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285003 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285002 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

00944285001 CUVITRU J1555 INJ CUVITRU, 100 MG 11/1/2019 12/31/2299

13533063540 GAMASTAN S-D J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

13533063513 GAMASTAN S-D J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

13533033540 GAMASTAN J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

13533033513 GAMASTAN J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

13533033512 GAMASTAN J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

13533033504 GAMASTAN J1460 GAMMA GLOBULIN 1 CC INJ 11/1/2019 12/31/2299

44206043993 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043940 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043892 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043820 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043791 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043710 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043690 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

44206043605 PRIVIGEN J1459 INJ IVIG PRIVIGEN 500 MG 11/1/2019 12/31/2299

68135002001 NAGLAZYME J1458 GALSULFASE INJECTION 11/1/2019 12/31/2299

00409386302 FOSCARNET SODIUM J1455 FOSCARNET SODIUM INJECTION 11/1/2019 12/31/2299

69639010501 AKYNZEO J1454 INJ FOSNETUPITANT, PALONOSET 7/1/2020 12/31/2299

69639010201 AKYNZEO J1454 INJ FOSNETUPITANT, PALONOSET 11/1/2019 12/31/2299

72606056901 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

72603010601 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

72205005401 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

72205002601 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

71839010401 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

71288041810 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

70860078010 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

69097083037 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

68180069001 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

68001042122 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

67457088910 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

63323097210 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

60505610501 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

43598094811 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

43598085911 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

16729024003 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

16714092901 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

16714012001 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00781349775 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

00591438579 FOSAPREPITANT DIMEGLUMINE J1453 FOSAPREPITANT INJECTION 11/1/2019 12/31/2299

Page 25: NDC - Procedure Code Crosswalk - Kentucky

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063323001002 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409788623 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409788113 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409340201 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409340001 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409120725 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409120715 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409120713 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00409120703 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338051141 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338050941 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338050748 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338050741 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338050548 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00338050348 GENTAMICIN SULFATE IN NS J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00085006904 GARAMYCIN J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

00944251402 HYQVIA J1575 HYQVIA 100MG IMMUNEGLOBULIN 11/1/2019 12/31/2299

00944251302 HYQVIA J1575 HYQVIA 100MG IMMUNEGLOBULIN 11/1/2019 12/31/2299

00944251202 HYQVIA J1575 HYQVIA 100MG IMMUNEGLOBULIN 11/1/2019 12/31/2299

00944251102 HYQVIA J1575 HYQVIA 100MG IMMUNEGLOBULIN 11/1/2019 12/31/2299

00944251002 HYQVIA J1575 HYQVIA 100MG IMMUNEGLOBULIN 11/1/2019 12/31/2299

70257005451 HEPAGAM B J1573 HEPAGAM B INTRAVENOUS, INJ 11/1/2019 12/31/2299

70257005405 HEPAGAM B J1573 HEPAGAM B INTRAVENOUS, INJ 11/1/2019 12/31/2299

70257005151 HEPAGAM B J1573 HEPAGAM B INTRAVENOUS, INJ 11/1/2019 12/31/2299

70257005105 HEPAGAM B J1573 HEPAGAM B INTRAVENOUS, INJ 11/1/2019 12/31/2299

61953000506 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000505 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000504 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000503 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000502 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000501 FLEBOGAMMA DIF J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

61953000301 FLEBOGAMMA J1572 FLEBOGAMMA INJECTION 11/1/2019 12/31/2299

70257005351 HEPAGAM B J1571 HEPAGAM B IM INJECTION 11/1/2019 12/31/2299

70257005311 HEPAGAM B J1571 HEPAGAM B IM INJECTION 11/1/2019 12/31/2299

70257005251 HEPAGAM B J1571 HEPAGAM B IM INJECTION 11/1/2019 12/31/2299

70257005211 HEPAGAM B J1571 HEPAGAM B IM INJECTION 11/1/2019 12/31/2299

70436008955 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

63323031594 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

63323031510 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

63323031501 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

61269045020 CYTOVENE J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

51754250003 GANCICLOVIR J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

51754250001 GANCICLOVIR J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

42023017325 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

42023017301 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

25021018511 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

25021018510 GANCICLOVIR SODIUM J1570 GANCICLOVIR SODIUM INJECTION 11/1/2019 12/31/2299

00944270013 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270012 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270011 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270010 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270009 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270008 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270007 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270006 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270005 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270004 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270003 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

00944270002 GAMMAGARD LIQUID J1569 GAMMAGARD LIQUID INJECTION 11/1/2019 12/31/2299

68982085005 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982085004 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982085003 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982085002 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982085001 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982084005 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982084004 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982084003 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982084002 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

68982084001 OCTAGAM J1568 OCTAGAM INJECTION 11/1/2019 12/31/2299

00944265908 GAMMAGARD S-D J1566 IMMUNE GLOBULIN, POWDER 11/1/2019 12/31/2299

00944265804 GAMMAGARD S-D J1566 IMMUNE GLOBULIN, POWDER 11/1/2019 12/31/2299

76125090051 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090050 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090021 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090020 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090011 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090010 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090002 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

76125090001 GAMMAKED J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080072 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080071 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080025 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080024 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080021 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080020 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

13533080016 GAMUNEX-C J1561 GAMUNEX-C/GAMMAKED 11/1/2019 12/31/2299

Page 26: NDC - Procedure Code Crosswalk - Kentucky

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067457042612 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

67457042600 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

63323047410 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

63323047401 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

63323047400 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

50458025501 HALDOL J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

25021080601 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

10147091101 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00703704501 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00703704104 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00703704101 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00143950201 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00143950125 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00143950101 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00143931925 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

00143931901 HALOPERIDOL LACTATE J1630 HALOPERIDOL INJECTION 11/1/2019 12/31/2299

57894064011 TREMFYA J1628 INJ., GUSELKUMAB, 1 MG 11/1/2019 12/31/2299

57894064001 TREMFYA J1628 INJ., GUSELKUMAB, 1 MG 11/1/2019 12/31/2299

47426010106 SUSTOL J1627 INJ, GRANISETRON, XR, 0.1 MG 11/1/2019 12/31/2299

67457086404 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

67457086301 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

63323031904 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

63323031801 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

63323031701 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

17478054605 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

17478054602 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00703797301 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00703797103 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00703789101 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00143974505 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00143974501 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00143974410 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00143974401 GRANISETRON HCL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

00004024009 KYTRIL J1626 GRANISETRON HCL INJECTION 11/1/2019 12/31/2299

63323059616 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059613 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059611 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059608 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059606 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059603 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059403 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

63323059303 GLUCAGON HCL J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

00597026010 GLUCAGEN J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

00597005345 GLUCAGEN J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

00597005301 GLUCAGEN J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

00169706515 GLUCAGEN J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

00002803101 GLUCAGON EMERGENCY KIT J1610 GLUCAGON HYDROCHLORIDE/1 MG 11/1/2019 12/31/2299

57894035001 SIMPONI ARIA J1602 GOLIMUMAB FOR IV USE 1MG 11/1/2019 12/31/2299

57894007102 SIMPONI J1602 GOLIMUMAB FOR IV USE 1MG 11/1/2019 12/31/2299

57894007101 SIMPONI J1602 GOLIMUMAB FOR IV USE 1MG 11/1/2019 12/31/2299

57894007002 SIMPONI J1602 GOLIMUMAB FOR IV USE 1MG 11/1/2019 12/31/2299

57894007001 SIMPONI J1602 GOLIMUMAB FOR IV USE 1MG 11/1/2019 12/31/2299

69800025002 ASCENIV J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

69800025001 ASCENIV J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082086 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082085 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082084 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082083 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082082 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082081 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082006 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082005 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082004 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082003 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082002 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

68982082001 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069155802 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069155801 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069141502 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069141501 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069131202 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069131201 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069122402 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069122401 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069110902 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069110901 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069101102 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

00069101101 PANZYGA J1599 IVIG NON-LYOPHILIZED, NOS 11/1/2019 12/31/2299

63323051302 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323017395 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323017394 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323017302 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323001096 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323001095 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323001094 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

63323001020 GENTAMICIN SULFATE J1580 GARAMYCIN GENTAMICIN INJ 11/1/2019 12/31/2299

Page 27: NDC - Procedure Code Crosswalk - Kentucky

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000409272003 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272002 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272001 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409140227 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409140212 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409131632 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409131611 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00338955210 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00338043304 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00338042418 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264987210 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264958720 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264957710 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264956710 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264570510 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00264570505 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069013703 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069013701 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069006202 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069006201 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005904 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005903 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005902 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005901 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005802 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069005801 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069004302 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00069004301 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

64253033335 HEPARIN FLUSH J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

64253033325 HEPARIN FLUSH J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

63323054501 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

63323054411 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

63323054401 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

63323001710 HEPARIN FLUSH J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

00409128033 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

00409128032 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

00409115270 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

00409115170 HEPARIN LOCK J1642 INJ HEPARIN SODIUM PER 10 U 11/1/2019 12/31/2299

55292070255 PANHEMATIN J1640 HEMIN, 1 MG 11/1/2019 12/31/2299

55292070254 PANHEMATIN J1640 HEMIN, 1 MG 11/1/2019 12/31/2299

72152054720 ZULRESSO J1632 INJ., BREXANOLONE, 1 MG 10/1/2020 12/31/2299

70710146405 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146401 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146305 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146301 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146201 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146109 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146106 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70710146101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038405 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038401 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038310 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038305 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038301 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038110 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069038101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069003105 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069003101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069003003 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

70069003001 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457041013 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457041000 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457040913 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457040900 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457038158 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

67457038100 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

63323047141 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

63323047105 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

63323047101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

63323046905 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

63323046901 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

50458025414 HALDOL DECANOATE 100 J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

50458025303 HALDOL DECANOATE 50 J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

25021083405 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

25021083301 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

25021083101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

10147092205 HALOPERIDOL DECANOATE 100 J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

10147092103 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703713301 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703713103 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703713101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703712301 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703712103 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00703712101 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00143929601 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

00143929501 HALOPERIDOL DECANOATE J1631 HALOPERIDOL DECANOATE INJ 11/1/2019 12/31/2299

Page 28: NDC - Procedure Code Crosswalk - Kentucky

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063323091503 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323091501 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054214 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054213 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054209 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054207 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054204 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054201 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054067 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054057 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054036 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054033 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054015 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054013 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054011 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054007 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054005 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054003 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323054001 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323052374 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323052277 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323051877 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323051774 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323045909 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323027602 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026255 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026236 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026226 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026211 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026209 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026206 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026203 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323026201 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323011805 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323011801 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323004710 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323004701 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040401 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040304 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040301 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040210 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040201 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040102 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040030 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040010 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

25021040001 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00781332771 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641620410 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641620401 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641619910 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641619901 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641246055 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641246030 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641245055 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641245030 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641041037 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641041012 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641040037 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641040012 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641039137 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00641039112 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409779362 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409779352 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409776113 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409776103 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409776013 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409776003 HEPARIN SODIUM-D5W J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765162 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765152 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765113 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765103 HEPARIN SODIUM-0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765062 HEPARIN SODIUM IN 0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409765052 HEPARIN SODIUM IN 0.45% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409762059 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409762049 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409762013 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409762003 HEPARIN SODIUM-0.9% NACL J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272331 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272330 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272302 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272301 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272130 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272101 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272032 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272031 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

00409272030 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

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000069021702 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069021701 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069020602 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069020601 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069019602 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069019601 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069019502 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

00069019501 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

76045010810 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

72572025525 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

72572025501 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

72572025025 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

72572025001 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042496 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042495 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042296 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042295 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042196 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042195 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042096 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288042095 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288041996 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288041995 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040405 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040404 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040402 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040401 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040311 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040310 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040302 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040301 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040231 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040230 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040211 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040210 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040202 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040201 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040102 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040101 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040003 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

71288040002 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095630 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095600 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095410 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095400 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095310 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095300 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095101 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095100 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095001 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457095000 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457094901 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457094900 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457094801 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457094800 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457060399 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457060305 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457060299 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457060202 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038599 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038510 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038499 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038431 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038399 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457038310 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037499 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037412 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037399 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037312 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037299 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

67457037212 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739098625 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739098611 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739096425 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739096411 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739095325 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739095311 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739094229 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739094215 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739093128 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739093114 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739092025 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739092011 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739090128 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63739090114 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

63323091513 HEPARIN SODIUM J1644 INJ HEPARIN SODIUM PER 1000U 11/1/2019 12/31/2299

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00069022001 FRAGMIN J1645 DALTEPARIN SODIUM 11/1/2019 12/31/2299

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16714005610 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

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16714001601 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

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67457058500 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058406 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058400 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058304 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058300 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058210 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

67457058200 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023310 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023300 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023210 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023200 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023110 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023100 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023010 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55150023000 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068111 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068110 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068102 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068011 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068010 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111068002 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067911 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067910 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067902 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067811 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067810 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

55111067802 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060911 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060910 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060902 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060811 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060810 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060802 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060711 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060710 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060702 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060611 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060610 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

43598060602 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781347695 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781347694 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781347612 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781346595 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781346594 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781346512 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781345495 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781345494 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781345412 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781344395 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781344394 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

00781344312 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

71288041183 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041182 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041181 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041180 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041089 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041088 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041087 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041086 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041085 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041084 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041083 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041082 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041081 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

71288041080 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046441 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046343 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046342 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046243 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046242 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

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68001046142 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046043 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

68001046042 ENOXAPARIN SODIUM J1650 INJ ENOXAPARIN SODIUM 11/1/2019 12/31/2299

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00002775201 INSULIN LISPRO JUNIOR KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002773701 INSULIN LISPRO J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002771559 BASAGLAR KWIKPEN U-100 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002771501 BASAGLAR KWIKPEN U-100 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002771459 HUMALOG JUNIOR KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002771401 HUMALOG JUNIOR KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751659 HUMALOG J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751601 HUMALOG J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751201 HUMALOG MIX 50-50 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751101 HUMALOG MIX 75-25 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751017 HUMALOG J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002751001 HUMALOG J1815 INSULIN INJECTION 11/1/2019 12/31/2299

63323060401 PROPRANOLOL HCL J1800 PROPRANOLOL INJECTION 11/1/2019 12/31/2299

00781377795 PROPRANOLOL HCL J1800 PROPRANOLOL INJECTION 11/1/2019 12/31/2299

00143987210 PROPRANOLOL HCL J1800 PROPRANOLOL INJECTION 11/1/2019 12/31/2299

00143987201 PROPRANOLOL HCL J1800 PROPRANOLOL INJECTION 11/1/2019 12/31/2299

00517970225 DROPERIDOL J1790 DROPERIDOL INJECTION 11/1/2019 12/31/2299

00517970201 DROPERIDOL J1790 DROPERIDOL INJECTION 11/1/2019 12/31/2299

00409118711 DROPERIDOL J1790 DROPERIDOL INJECTION 11/1/2019 12/31/2299

00409118701 DROPERIDOL J1790 DROPERIDOL INJECTION 11/1/2019 12/31/2299

58468466301 CEREZYME J1786 IMUGLUCERASE INJECTION 11/1/2019 12/31/2299

49230053425 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

49230053410 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

49230053025 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

49230053010 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517234099 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517234025 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517234010 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517234001 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517232510 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517232501 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517231005 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00517231001 VENOFER J1756 IRON SUCROSE INJECTION 11/1/2019 12/31/2299

00023608210 INFED J1750 INJ IRON DEXTRAN 11/1/2019 12/31/2299

00023608201 INFED J1750 INJ IRON DEXTRAN 11/1/2019 12/31/2299

62064012202 TROGARZO J1746 INJ., IBALIZUMAB-UIYK, 10 MG 11/1/2019 12/31/2299

62064012201 TROGARZO J1746 INJ., IBALIZUMAB-UIYK, 10 MG 11/1/2019 12/31/2299

57894003001 REMICADE J1745 INFLIXIMAB NOT BIOSIMIL 10MG 11/1/2019 12/31/2299

54092070001 ELAPRASE J1743 IDURSULFASE INJECTION 11/1/2019 12/31/2299

67457036610 IBUTILIDE FUMARATE J1742 IBUTILIDE FUMARATE INJECTION 11/1/2019 12/31/2299

00009379422 CORVERT J1742 IBUTILIDE FUMARATE INJECTION 11/1/2019 12/31/2299

00009379401 CORVERT J1742 IBUTILIDE FUMARATE INJECTION 11/1/2019 12/31/2299

66220028422 CALDOLOR J1741 IBUPROFEN INJECTION 11/1/2019 12/31/2299

66220028411 CALDOLOR J1741 IBUPROFEN INJECTION 11/1/2019 12/31/2299

67457052433 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

62756021840 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

60505609700 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

55150019183 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

25021082761 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

25021082273 IBANDRONATE SODIUM J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

00004019109 BONIVA J1740 IBANDRONATE SODIUM INJECTION 11/1/2019 12/31/2299

71518000101 ANJESO J1738 INJ. MELOXICAM 1 MG 10/1/2020 12/31/2299

67457088605 HYDROXYPROGESTERONE CAPROATE J1729 INJ HYDROXYPROGST CAPOAT NOS 11/1/2019 12/31/2299

71225010501 HYDROXYPROGESTERONE CAPROATE J1726 MAKENA, 10 MG 11/1/2019 12/31/2299

71225010401 HYDROXYPROGESTERONE CAPROATE J1726 MAKENA, 10 MG 11/1/2019 12/31/2299

69238179701 HYDROXYPROGESTERONE CAPROATE J1726 MAKENA, 10 MG 11/1/2019 12/31/2299

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55150031001 HYDROXYPROGESTERONE CAPROATE J1726 MAKENA, 10 MG 11/1/2019 12/31/2299

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00517176701 HYDROXYPROGESTERONE CAPROATE J1726 MAKENA, 10 MG 11/1/2019 12/31/2299

00409485605 A-HYDROCORT J1720 HYDROCORTISONE SODIUM SUCC I 11/1/2019 12/31/2299

00074567304 A-HYDROCORT J1720 HYDROCORTISONE SODIUM SUCC I 11/1/2019 12/31/2299

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00009000501 SOLU-CORTEF J1720 HYDROCORTISONE SODIUM SUCC I 11/1/2019 12/31/2299

13533063420 HYPERTET S-D J1670 TETANUS IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063402 HYPERTET S-D J1670 TETANUS IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

70710151709 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151706 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151702 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151609 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151606 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151602 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151509 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151506 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

70710151502 FONDAPARINUX SODIUM J1652 FONDAPARINUX SODIUM 11/1/2019 12/31/2299

Page 34: NDC - Procedure Code Crosswalk - Kentucky

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73070010215 INSULIN ASPART PENFILL J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00169643890 LEVEMIR FLEXTOUCH J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00169300325 NOVOLIN R FLEXPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00169183402 NOVOLIN N J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00088502101 LANTUS J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00024592605 ADMELOG J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00024592505 ADMELOG SOLOSTAR J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00002880559 HUMULIN N KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002880501 HUMULIN N KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002880359 HUMULIN 70/30 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002880301 HUMULIN 70/30 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879959 HUMALOG KWIKPEN U-100 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879901 HUMALOG KWIKPEN U-100 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879859 HUMALOG MIX 50-50 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879801 HUMALOG MIX 50-50 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879759 HUMALOG MIX 75-25 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

00002879701 HUMALOG MIX 75-25 KWIKPEN J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00002850101 HUMULIN R U-500 J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00002831501 HUMULIN N J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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00002821517 HUMULIN R J1815 INSULIN INJECTION 11/1/2019 12/31/2299

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000409610227 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610226 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610225 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610220 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610219 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610218 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610210 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610204 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610202 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409163921 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409163910 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

58468007001 ALDURAZYME J1931 LARONIDASE INJECTION 11/1/2019 12/31/2299

15054112004 SOMATULINE DEPOT J1930 LANREOTIDE INJECTION 11/1/2019 12/31/2299

15054109004 SOMATULINE DEPOT J1930 LANREOTIDE INJECTION 11/1/2019 12/31/2299

15054106004 SOMATULINE DEPOT J1930 LANREOTIDE INJECTION 11/1/2019 12/31/2299

76045010710 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

76045010410 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611072525 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611072501 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611072225 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611072201 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611071925 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72611071901 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72266011925 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72266011901 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72266011825 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

72266011801 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070142 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070141 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070104 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070103 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070101 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070041 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070002 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

70860070001 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016226 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016216 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016214 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016212 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016203 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016202 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016201 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016200 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016116 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016112 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

63323016101 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058568 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058546 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058493 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058468 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058393 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

47781058368 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

25021070102 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

25021070101 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

25021070001 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00641604225 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00641604201 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00641604125 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00641604101 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379619 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379601 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379519 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379501 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379319 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409379301 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228831 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228821 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228761 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228731 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228723 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228720 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228704 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00409228703 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00338007225 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00338006910 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00074228754 KETOROLAC TROMETHAMINE J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00004692206 TORADOL J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00004692106 TORADOL J1885 KETOROLAC TROMETHAMINE INJ 11/1/2019 12/31/2299

00469042099 CRESEMBA J1833 INJECTION, ISAVUCONAZONIUM 11/1/2019 12/31/2299

50419052435 BETASERON J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

50419052401 BETASERON J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

50419052309 BETASERON J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

50419052201 BETASERON J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

00078056999 EXTAVIA J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

00078056961 EXTAVIA J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

00078056912 EXTAVIA J1830 INTERFERON BETA-1B / .25 MG 11/1/2019 12/31/2299

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050474000263 KEPPRA J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075952 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075910 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075752 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075710 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075552 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598075510 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063752 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063710 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063652 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063610 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063552 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

43598063510 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

39822400001 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

25021078005 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789033015 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789033008 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789022010 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789022008 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789011008 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

14789011005 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00409188622 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00409188615 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00409188605 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00409188602 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00143967325 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00143967301 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00143957425 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00143957401 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

00074366304 LUPRON DEPOT (LUPANETA) J1950 LEUPROLIDE ACETATE /3.75 MG 11/1/2019 12/31/2299

00074366303 LUPRON DEPOT J1950 LEUPROLIDE ACETATE /3.75 MG 11/1/2019 12/31/2299

00074364107 LUPRON DEPOT (LUPANETA) J1950 LEUPROLIDE ACETATE /3.75 MG 11/1/2019 12/31/2299

00074364104 LUPRON DEPOT (LUPANETA) J1950 LEUPROLIDE ACETATE /3.75 MG 11/1/2019 12/31/2299

00074364103 LUPRON DEPOT J1950 LEUPROLIDE ACETATE /3.75 MG 11/1/2019 12/31/2299

65757040403 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040401 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040303 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040301 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040203 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040201 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040103 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757040101 ARISTADA J1944 ARIPIRAZOLE LAUROXIL 1 MG 11/1/2019 12/31/2299

65757050003 ARISTADA INITIO J1943 INJ., ARISTADA INITIO, 1 MG 11/1/2019 12/31/2299

70121107605 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

70121107601 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075912 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075911 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075910 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075903 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075902 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

64679075901 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028036 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028026 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028016 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028010 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028005 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028004 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028003 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028002 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

63323028001 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032425 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032401 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032325 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032301 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032225 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

55150032201 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

36000028425 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

36000028325 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

36000028225 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052144 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052142 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052141 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052133 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052132 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155052131 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047344 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047342 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047341 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047333 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047332 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

23155047331 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409963114 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409963104 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610237 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610236 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

00409610235 FUROSEMIDE J1940 FUROSEMIDE INJECTION 11/1/2019 12/31/2299

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000264959420 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00264959410 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00264937688 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143959525 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143959501 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143959425 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143959401 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143957710 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143957701 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143957510 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00143957501 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00074625401 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00074624801 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00074621702 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00037900105 LEVSIN J1980 HYOSCYAMINE SULFATE INJ 11/1/2019 12/31/2299

63323035565 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

63323035560 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

63323035550 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

55150024552 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

55150024447 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

55150024346 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

55150015730 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

55150015620 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

44567043724 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

44567043624 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

44567043524 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000029624 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000029524 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000029424 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000004824 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000004724 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000004624 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

36000004501 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

25021013283 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

25021013282 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

25021013281 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

23155020132 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

23155020131 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

17478010730 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

17478010720 LEVOFLOXACIN J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052835 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052831 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052825 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052823 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052815 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00409052813 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972224 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972201 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972124 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972101 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972024 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143972001 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931724 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931701 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931624 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931601 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931524 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

00143931501 LEVOFLOXACIN-D5W J1956 LEVOFLOXACIN INJECTION 11/1/2019 12/31/2299

54482014701 CARNITOR J1955 INJ LEVOCARNITINE PER 1 GM 11/1/2019 12/31/2299

70860060482 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

70860060441 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

70860060382 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

70860060341 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

70860060282 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

70860060241 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457079005 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457079000 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457026610 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457026600 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457026510 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457026500 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457025510 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

67457025500 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

63323040044 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

63323040041 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

63323040009 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

63323040005 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

62756051344 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

62756051340 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

55150024847 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

55150024747 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

55150024647 LEVETIRACETAM-NACL J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

55150017705 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

51224001325 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

51224001310 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

51224001301 LEVETIRACETAM J1953 LEVETIRACETAM INJECTION 11/1/2019 12/31/2299

Page 38: NDC - Procedure Code Crosswalk - Kentucky

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063323049216 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049209 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049208 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049207 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049204 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049157 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049101 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048657 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048641 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048627 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048626 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048617 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048605 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048602 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048601 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048557 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048541 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048527 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048526 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048503 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048501 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323048457 XYLOCAINE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323020805 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323020202 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323020110 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323020102 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025650 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025520 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025410 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025350 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025220 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150025110 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150016505 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150016402 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150016330 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150016205 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150016102 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150015974 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

55150015872 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409913711 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409913705 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409793932 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409490434 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409490411 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409490334 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409490311 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409477610 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409477601 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471375 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471365 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471362 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471342 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471332 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471325 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471312 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471302 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471211 LIDOCAINE HCL IN 7.5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409471201 LIDOCAINE HCL IN 7.5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409428325 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409428311 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409428301 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427916 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427902 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427816 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427801 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427717 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427716 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427702 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427701 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427617 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427616 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427602 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427601 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427516 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409427501 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409206610 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409206605 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409132315 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00409132305 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00338041103 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00338041102 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00338040904 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00338040903 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00338040704 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00264959820 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

00264959810 LIDOCAINE HCL IN 5% DEXTROSE J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

Page 39: NDC - Procedure Code Crosswalk - Kentucky

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000641620701 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604925 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604901 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604825 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604801 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604710 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604701 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604610 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604601 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604525 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604501 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604425 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641604401 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600325 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600301 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600210 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600201 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600125 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641600101 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409678011 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409678002 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677911 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677902 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677862 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677815 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677811 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677805 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409677802 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409198530 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409198503 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409153931 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00409153903 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

67457084330 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

67457084300 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

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63323071313 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

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57664068357 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

57664068331 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

55150024251 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

25021016987 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

00781343395 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

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00703906033 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

00703906031 LINEZOLID-D5W J2020 LINEZOLID INJECTION 11/1/2019 12/31/2299

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54859040210 LINCOJECT J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

39822035306 LINCOMYCIN HCL J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

39822035305 LINCOMYCIN HCL J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

39822035002 LINCOMYCIN HCL J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

39822035001 LINCOMYCIN HCL J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

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00009055501 LINCOCIN J2010 LINCOMYCIN INJECTION 11/1/2019 12/31/2299

76329339001 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

72572037225 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

72572037201 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

72572037025 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

72572037001 LIDOCAINE HCL J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049697 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049603 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049541 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049527 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049526 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049509 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049507 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049504 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049397 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049391 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049297 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049289 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049280 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049257 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049245 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049243 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049241 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049237 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049236 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049231 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049227 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

63323049226 XYLOCAINE-MPF J2001 LIDOCAINE INJECTION 11/1/2019 12/31/2299

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051991014417 METHYLERGONOVINE MALEATE J2210 METHYLERGONOVIN MALEATE INJ 11/1/2019 12/31/2299

00517074020 METHYLERGONOVINE MALEATE J2210 METHYLERGONOVIN MALEATE INJ 11/1/2019 12/31/2299

00517074001 METHYLERGONOVINE MALEATE J2210 METHYLERGONOVIN MALEATE INJ 11/1/2019 12/31/2299

70842012006 VABOMERE J2186 INJ., MEROPENEM, VABORBACTAM 11/1/2019 12/31/2299

70842012001 VABOMERE J2186 INJ., MEROPENEM, VABORBACTAM 11/1/2019 12/31/2299

72572041610 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

72572041601 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

72572041510 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

72572041501 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

71288001531 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

71288001530 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

71288001421 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

71288001420 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

70121145407 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

70121145401 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

70121145307 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

70121145301 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

68001044758 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

68001044757 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

68001044631 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

68001044629 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050831 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050830 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050825 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050725 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050721 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

63323050720 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

55150020830 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

55150020720 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

44567040110 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

44567040101 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

44567040010 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

44567040001 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

00781309895 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

00781300095 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

00409350611 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

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00409350511 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

00409350501 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

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00409139121 MEROPENEM J2185 MEROPENEM 11/1/2019 12/31/2299

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00069031410 MERREM J2185 MEROPENEM 11/1/2019 12/31/2299

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00069031310 MERREM J2185 MEROPENEM 11/1/2019 12/31/2299

00069031301 MERREM J2185 MEROPENEM 11/1/2019 12/31/2299

00173089261 NUCALA J2182 INJECTION, MEPOLIZUMAB, 1MG 11/1/2019 12/31/2299

00173089242 NUCALA J2182 INJECTION, MEPOLIZUMAB, 1MG 11/1/2019 12/31/2299

00173089201 NUCALA J2182 INJECTION, MEPOLIZUMAB, 1MG 11/1/2019 12/31/2299

00173088101 NUCALA J2182 INJECTION, MEPOLIZUMAB, 1MG 11/1/2019 12/31/2299

00641605425 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00641605401 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00641605325 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00641605301 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00641605225 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00641605201 MEPERIDINE HCL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409125611 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409125601 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

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00409125411 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409125401 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409120120 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409118130 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409118069 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

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00409117903 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409117830 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409117803 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409117630 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00409117603 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00074126601 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

00074117921 DEMEROL J2175 MEPERIDINE HYDROCHL /100 MG 11/1/2019 12/31/2299

15054104005 INCRELEX J2170 MECASERMIN INJECTION 11/1/2019 12/31/2299

63323002425 MANNITOL J2150 MANNITOL INJECTION 11/1/2019 12/31/2299

00409403116 MANNITOL J2150 MANNITOL INJECTION 11/1/2019 12/31/2299

00409403101 MANNITOL J2150 MANNITOL INJECTION 11/1/2019 12/31/2299

76329826101 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

76329826100 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

72572038025 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

72572038001 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

17478004001 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

10019010346 ATIVAN J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

00641620725 LORAZEPAM J2060 LORAZEPAM INJECTION 11/1/2019 12/31/2299

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063323041113 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

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00641605725 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

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00641605610 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

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00409230869 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230850 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230849 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230822 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230821 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230802 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230801 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230760 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230703 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230662 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230612 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230611 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230603 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230555 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230550 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230517 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230516 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230505 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

00409230504 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

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00004194701 VERSED J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323072910 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

63323072901 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

63323072810 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

63323072801 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

60505612006 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

60505612000 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

60505611905 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

60505611900 MICAFUNGIN J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

00469325050 MYCAMINE J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

00469325010 MYCAMINE J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

00469321199 MYCAMINE J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

00469321110 MYCAMINE J2248 MICAFUNGIN SODIUM INJECTION 11/1/2019 12/31/2299

63704000401 METHYLERGONOVINE MALEATE J2210 METHYLERGONOVIN MALEATE INJ 11/1/2019 12/31/2299

51991014499 METHYLERGONOVINE MALEATE J2210 METHYLERGONOVIN MALEATE INJ 11/1/2019 12/31/2299

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00409189301 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189211 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189210 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189103 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189101 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189003 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00409189001 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00121090494 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00121090405 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00074126011 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00054023763 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00054023749 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

71288020050 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

71288020021 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

71288020020 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

71288020011 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

71288020010 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

63323061750 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

63323061720 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

63323061710 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

55150028810 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

55150028801 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

55150028710 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

55150028701 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409277643 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409277623 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409277622 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409277602 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409277502 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409021211 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409021210 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409021203 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409021202 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00409021201 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00338601137 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00338601048 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971910 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971901 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971810 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971801 MILRINONE IN 5% DEXTROSE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971010 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143971001 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143970910 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143970901 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143970801 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143932610 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

00143932601 MILRINONE LACTATE J2260 INJ MILRINONE LACTATE / 5 MG 11/1/2019 12/31/2299

76045000210 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

76045000120 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72611074910 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72611074901 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72572043210 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72572043201 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72572043025 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

72572043001 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060142 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060141 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060110 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060105 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060041 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

70860060002 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

66758001902 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

66758001802 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041225 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041218 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041213 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041210 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041206 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041205 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041203 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041202 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041125 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041118 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

63323041115 MIDAZOLAM HCL J2250 INJ MIDAZOLAM HYDROCHLORIDE 11/1/2019 12/31/2299

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000409146501 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146461 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146401 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146371 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146369 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146349 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146301 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

67457032325 MOXIFLOXACIN J2280 INJ, MOXIFLOXACIN 100 MG 11/1/2019 12/31/2299

63323085074 MOXIFLOXACIN J2280 INJ, MOXIFLOXACIN 100 MG 11/1/2019 12/31/2299

50419053701 AVELOX IV J2280 INJ, MOXIFLOXACIN 100 MG 11/1/2019 12/31/2299

70720072310 PRIALT J2278 ZICONOTIDE INJECTION 11/1/2019 12/31/2299

70720072210 PRIALT J2278 ZICONOTIDE INJECTION 11/1/2019 12/31/2299

70720072010 PRIALT J2278 ZICONOTIDE INJECTION 11/1/2019 12/31/2299

76329191101 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000810 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000710 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000610 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000511 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000510 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000501 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000411 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000410 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76045000401 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

66794016202 MITIGO J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

63323029280 ASTRAMORPH-PF J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

63323029210 ASTRAMORPH-PF J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

63323029180 ASTRAMORPH-PF J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

63323029110 ASTRAMORPH-PF J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641604001 INFUMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641603901 INFUMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641602010 DURAMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641602001 DURAMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641601910 DURAMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00641601901 DURAMORPH J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409602804 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409381512 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409381511 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409381412 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409381411 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409202902 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189303 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189301 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189203 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189201 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189111 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189110 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189103 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189101 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189023 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189013 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189011 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189010 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189003 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409189001 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00409113502 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

00074126011 MORPHINE SULFATE J2274 INJ MORPHINE PF EPID ITHC 11/1/2019 12/31/2299

76329191101 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000810 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000710 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000511 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000510 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000501 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000411 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000410 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

76045000401 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

72572044025 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

72572044001 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

68094000162 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

68094000159 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

66794016202 MITIGO J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045801 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045800 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045501 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045500 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045401 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045400 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045201 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045200 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045101 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323045100 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

63323029110 ASTRAMORPH-PF J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

62559017005 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

62559017001 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

57664035835 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

57664035831 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

00641612625 MORPHINE SULFATE J2270 MORPHINE SULFATE INJECTION 11/1/2019 12/31/2299

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062756034944 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756034844 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756009444 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756009440 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

25021045505 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

25021045405 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

25021045301 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

25021045201 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

25021045101 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

23155068631 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

23155068531 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00781316575 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00781316475 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703334301 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703333301 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703332104 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703332101 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703331104 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703331101 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703330104 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00703330101 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617801 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617701 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617610 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617601 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617510 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617501 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617410 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00641617401 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018261 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018201 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018161 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018101 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018061 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078018001 SANDOSTATIN J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

00078082581 SANDOSTATIN LAR DEPOT J2353 OCTREOTIDE INJECTION, DEPOT 11/1/2019 12/31/2299

00078081881 SANDOSTATIN LAR DEPOT J2353 OCTREOTIDE INJECTION, DEPOT 11/1/2019 12/31/2299

00078080461 SANDOSTATIN LAR DEPOT J2353 OCTREOTIDE INJECTION, DEPOT 11/1/2019 12/31/2299

00078079761 SANDOSTATIN LAR DEPOT J2353 OCTREOTIDE INJECTION, DEPOT 11/1/2019 12/31/2299

50242015001 OCREVUS J2350 INJECTION, OCRELIZUMAB, 1 MG 11/1/2019 12/31/2299

64406000801 TYSABRI J2323 NATALIZUMAB INJECTION 11/1/2019 12/31/2299

65757030202 VIVITROL J2315 NALTREXONE, DEPOT FORM 11/1/2019 12/31/2299

65757030001 VIVITROL J2315 NALTREXONE, DEPOT FORM 11/1/2019 12/31/2299

76329346901 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

76329336901 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

76329146901 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

72572045025 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

72572045001 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

70069007210 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

70069007201 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

70069007110 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

70069007101 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457098710 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457098700 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457064502 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457064500 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457059902 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457059900 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457029910 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457029900 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457029202 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

67457029200 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

55150032810 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

55150032801 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

55150032710 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

55150032701 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

43598075058 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

43598075011 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

17478004210 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

17478004101 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

10019003968 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00641613225 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00641613201 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409178269 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409178203 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121941 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121930 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121925 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121901 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121525 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121521 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409121501 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00074178221 NALOXONE HCL J2310 INJ NALOXONE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146761 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146701 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

00409146571 NALBUPHINE HCL J2300 INJ NALBUPHINE HYDROCHLORIDE 11/1/2019 12/31/2299

Page 45: NDC - Procedure Code Crosswalk - Kentucky

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063323047801 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

63323047727 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

63323047701 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

63323047637 NESACAINE J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

63323047537 NESACAINE J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

63323047501 NESACAINE J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00186099466 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00186099366 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00143921010 CHLOROPROCAINE HCL J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00143921001 CHLOROPROCAINE HCL J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00143920910 CHLOROPROCAINE HCL J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

00143920901 CHLOROPROCAINE HCL J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

72572057125 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

72572057101 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

72572057010 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

72572057001 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

71863020206 BIORPHEN J2370 PHENYLEPHRINE HCL INJECTION 1/1/2020 12/31/2299

71863020205 BIORPHEN J2370 PHENYLEPHRINE HCL INJECTION 1/1/2020 12/31/2299

71288080877 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

71288080876 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

71288080875 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

71288080702 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

71288080701 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

70121157901 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

70121157807 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

70121157801 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

70121157705 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

70121157701 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

66758001602 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075113 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075110 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075105 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075103 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075101 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

63323075100 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021301 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021300 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021202 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021200 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021103 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

61990021100 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

42023021501 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

42023021410 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

42023021401 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

42023021325 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

42023021301 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

25021031599 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

25021031598 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

25021031501 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00781346670 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00781345895 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00781345875 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00781342292 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00781342271 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641622925 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641622901 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641618910 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641618901 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641618810 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641618801 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641614225 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

00641614201 PHENYLEPHRINE HCL J2370 PHENYLEPHRINE HCL INJECTION 11/1/2019 12/31/2299

25021065102 ORPHENADRINE CITRATE J2360 ORPHENADRINE INJECTION 11/1/2019 12/31/2299

17478053802 ORPHENADRINE CITRATE J2360 ORPHENADRINE INJECTION 11/1/2019 12/31/2299

00641618210 ORPHENADRINE CITRATE J2360 ORPHENADRINE INJECTION 11/1/2019 12/31/2299

00641618201 ORPHENADRINE CITRATE J2360 ORPHENADRINE INJECTION 11/1/2019 12/31/2299

00002763711 ZYPREXA RELPREVV J2358 OLANZAPINE LONG-ACTING INJ 11/1/2019 12/31/2299

00002763611 ZYPREXA RELPREVV J2358 OLANZAPINE LONG-ACTING INJ 11/1/2019 12/31/2299

00002763511 ZYPREXA RELPREVV J2358 OLANZAPINE LONG-ACTING INJ 11/1/2019 12/31/2299

50242021586 XOLAIR J2357 OMALIZUMAB INJECTION 11/1/2019 12/31/2299

50242021501 XOLAIR J2357 OMALIZUMAB INJECTION 11/1/2019 12/31/2299

50242021401 XOLAIR J2357 OMALIZUMAB INJECTION 11/1/2019 12/31/2299

50242004086 XOLAIR J2357 OMALIZUMAB INJECTION 11/1/2019 12/31/2299

50242004062 XOLAIR J2357 OMALIZUMAB INJECTION 11/1/2019 12/31/2299

63323037905 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323037805 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323037704 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323037701 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323037604 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323037601 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323036504 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

63323036501 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756045236 BYNFEZIA J2354 OCTREOTIDE INJ, NON-DEPOT 4/1/2020 12/31/2299

62756035240 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756035144 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

62756035040 OCTREOTIDE ACETATE J2354 OCTREOTIDE INJ, NON-DEPOT 11/1/2019 12/31/2299

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050742048505 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

25021078874 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

25021078305 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

16729036566 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

16714083401 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00781341575 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00781331275 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00703409401 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00409250410 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00143951301 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

00049077009 TERRAMYCIN J2460 OXYTETRACYCLINE INJECTION 11/1/2019 12/31/2299

00049076009 TERRAMYCIN IM J2460 OXYTETRACYCLINE INJECTION 11/1/2019 12/31/2299

00517400225 PAPAVERINE HCL J2440 PAPAVERIN HCL INJECTION 11/1/2019 12/31/2299

67457044610 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

67457043010 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

63323073510 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

63323073410 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

61703032618 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

61703032518 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

61703032439 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

61703032418 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

59923060310 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

59923060110 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

00703408551 PAMIDRONATE DISODIUM J2430 PAMIDRONATE DISODIUM /30 MG 11/1/2019 12/31/2299

50458056401 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

50458056303 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

50458056301 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

50458056201 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

50458056101 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

50458056001 INVEGA SUSTENNA J2426 PALIPERIDONE PALMITATE INJ 11/1/2019 12/31/2299

66658011206 KEPIVANCE J2425 PALIFERMIN INJECTION 11/1/2019 12/31/2299

66658011203 KEPIVANCE J2425 PALIFERMIN INJECTION 11/1/2019 12/31/2299

66658011201 KEPIVANCE J2425 PALIFERMIN INJECTION 11/1/2019 12/31/2299

70842014003 ORBACTIV J2407 INJECTION, ORITAVANCIN 11/1/2019 12/31/2299

70842014001 ORBACTIV J2407 INJECTION, ORITAVANCIN 11/1/2019 12/31/2299

76045010320 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

72572052025 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

72572052001 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

72266012401 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

72266012325 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

72266012301 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

70860077720 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

70860077641 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

70860077602 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

67457044120 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

67457044022 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

67457044000 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

63323037420 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

63323037302 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

62756018201 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

62756018101 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

60505613005 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

60505613000 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

55150012620 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

55150012502 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

36000001301 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

36000001225 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

25021078220 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

25021077702 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155055031 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054931 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054842 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054841 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054831 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054742 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054741 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155054731 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155037731 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155019643 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155019642 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155019631 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

23155016831 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

16729029805 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00703722603 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00703722601 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00641608025 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00641608001 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00641607901 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00641607825 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00641607801 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00409475901 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00409475518 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00409475503 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00143989010 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

00143989001 ONDANSETRON HCL J2405 ONDANSETRON HCL INJECTION 11/1/2019 12/31/2299

63323047827 NESACAINE-MPF J2400 CHLOROPROCAINE HCL INJECTION 11/1/2019 12/31/2299

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63323032320 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

44567031201 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

44567031110 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00781613694 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00781613595 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00781613594 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00338102541 PENICILLIN GK-ISO-OSM DEXTROSE J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00338102341 PENICILLIN GK-ISO-OSM DEXTROSE J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00338102141 PENICILLIN GK-ISO-OSM DEXTROSE J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049053028 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049053022 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049052084 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049052083 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049052023 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049052022 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049043020 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049042010 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

00049042005 PFIZERPEN J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

60793013110 PENICILLIN G PROCAINE J2510 PENICILLIN G PROCAINE INJ 11/1/2019 12/31/2299

60793013101 PENICILLIN G PROCAINE J2510 PENICILLIN G PROCAINE INJ 11/1/2019 12/31/2299

60793013010 PENICILLIN G PROCAINE J2510 PENICILLIN G PROCAINE INJ 11/1/2019 12/31/2299

60793013001 PENICILLIN G PROCAINE J2510 PENICILLIN G PROCAINE INJ 11/1/2019 12/31/2299

75987008010 KRYSTEXXA J2507 PEGLOTICASE INJECTION 11/1/2019 12/31/2299

55513019201 NEULASTA ONPRO J2505 INJECTION, PEGFILGRASTIM 6MG 11/1/2019 12/31/2299

55513019001 NEULASTA J2505 INJECTION, PEGFILGRASTIM 6MG 11/1/2019 12/31/2299

55292014301 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292014201 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292014101 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292014001 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013901 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013801 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013701 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013601 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013501 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

55292013401 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078076961 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078075561 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078074881 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078074181 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064381 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064361 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064281 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064261 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064181 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

00078064161 SIGNIFOR LAR J2502 INJ, PASIREOTIDE LONG ACTING 11/1/2019 12/31/2299

67457038925 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

67457038922 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

67457038025 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

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43598056325 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

43598056311 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

16729031193 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

16729031163 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

16729031130 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

16729031108 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

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00409100801 PARICALCITOL J2501 PARICALCITOL 11/1/2019 12/31/2299

00074463701 ZEMPLAR J2501 PARICALCITOL 11/1/2019 12/31/2299

00074165805 ZEMPLAR J2501 PARICALCITOL 11/1/2019 12/31/2299

00074165801 ZEMPLAR J2501 PARICALCITOL 11/1/2019 12/31/2299

69639010301 ALOXI J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

69543037110 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

69543037101 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

69097092735 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

69097043935 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

68001035525 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

67457031725 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

63323067389 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

63323067321 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

63323067305 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

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60505619301 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

55150018605 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

55111069407 PALONOSETRON HCL J2469 PALONOSETRON HCL 11/1/2019 12/31/2299

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63323098254 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323098252 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323098243 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323098221 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323098153 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323098141 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

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63323098121 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323030494 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

63323030478 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

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00781921491 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781921395 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781921390 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781921095 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781921090 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311495 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311491 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311395 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311390 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311095 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00781311090 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409339011 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409339004 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409338513 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409338511 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409338311 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409338302 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337911 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337904 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337813 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337811 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337411 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00409337402 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886202 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886201 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886102 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886101 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886002 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206886001 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885910 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885516 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885508 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885416 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885408 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885216 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

00206885208 ZOSYN J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012751 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

70860012641 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

70860012620 PENICILLIN G POTASSIUM J2540 PENICILLIN G POTASSIUM INJ 11/1/2019 12/31/2299

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063323001210 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001207 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001206 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001203 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001202 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

42023013006 PITOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

42023011625 PITOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

42023011602 PITOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

00024586201 MOZOBIL J2562 PLERIXAFOR INJECTION 11/1/2019 12/31/2299

42494041625 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

42494041603 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

42494041601 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

42494041525 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

42494041503 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

42494041501 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

00641047725 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

00641047721 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

00641047625 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

00641047621 PHENOBARBITAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

00409234931 LUMINAL SODIUM J2560 PHENOBARBITAL SODIUM INJ 11/1/2019 12/31/2299

39822555006 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

39822555005 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

39822552503 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

39822552502 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641620825 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641620801 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608525 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608501 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608425 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608401 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608325 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608301 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608225 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641608201 PHENERGAN J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641149635 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641149631 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641149535 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641149531 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641095625 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641095621 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641095525 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641095521 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641094935 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641094931 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641094835 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641094831 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641092925 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641092921 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641092825 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00641092821 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00409231231 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

00409231202 PROMETHAZINE HCL J2550 PROMETHAZINE HCL INJECTION 11/1/2019 12/31/2299

72769018103 RAPIVAB J2547 INJECTION, PERAMIVIR 11/1/2019 12/31/2299

72769018101 RAPIVAB J2547 INJECTION, PERAMIVIR 11/1/2019 12/31/2299

63323087715 NEBUPENT J2545 PENTAMIDINE NON-COMP UNIT 11/1/2019 12/31/2299

13925052201 PENTAMIDINE ISETHIONATE J2545 PENTAMIDINE NON-COMP UNIT 11/1/2019 12/31/2299

72572057410 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

72572057401 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

72572057310 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

72572057301 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000451 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000450 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000331 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000330 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000231 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

71288000230 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012399 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012250 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012241 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012141 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012130 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012041 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

70860012020 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052345 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052300 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052237 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052200 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052122 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

67457052100 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021841 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021802 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021741 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021702 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021641 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

66794021602 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

64679067902 PIPERACILLIN-TAZOBACTAM J2543 PIPERACILLIN/TAZOBACTAM 11/1/2019 12/31/2299

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000591213651 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469962 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469954 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469953 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469950 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469933 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469930 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00409469924 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069024810 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069024801 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069023420 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069023401 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069020910 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00069020901 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

70655010995 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

70655010980 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

70655009985 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022741 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022715 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022641 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022602 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022541 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

66794022502 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679070003 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679070002 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679069902 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679069901 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679069802 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

64679069801 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

63323081320 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

63323081301 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

63323081220 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

63323081201 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

63323081100 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

55150012999 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

55150012909 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

55150012825 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

55150012824 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

55150012715 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021016399 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021016397 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021016368 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021016268 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021016224 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

25021014610 OXACILLIN SODIUM J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

00338101541 OXACILLIN J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

00338101341 OXACILLIN J2700 OXACILLIN SODIUM INJECITON 11/1/2019 12/31/2299

14789090110 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

14789090107 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

14789090007 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

14789090002 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409190341 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409190301 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409190211 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409190201 PROCAINAMIDE HCL J2690 PROCAINAMIDE HCL INJECTION 11/1/2019 12/31/2299

67457035959 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

63323027205 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

55150026705 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

42023012989 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

42023012901 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

00143952901 FLUPHENAZINE DECANOATE J2680 FLUPHENAZINE DECANOATE 25 MG 11/1/2019 12/31/2299

63323026110 PROGESTERONE J2675 INJ PROGESTERONE PER 50 MG 11/1/2019 12/31/2299

55150030610 PROGESTERONE J2675 INJ PROGESTERONE PER 50 MG 11/1/2019 12/31/2299

00591312879 PROGESTERONE J2675 INJ PROGESTERONE PER 50 MG 11/1/2019 12/31/2299

00143972501 PROGESTERONE J2675 INJ PROGESTERONE PER 50 MG 11/1/2019 12/31/2299

70860045441 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

70860045410 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

70860045401 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

69918090110 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

69918089910 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

69918089901 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

62756052940 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

62756052926 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

55566230000 DDAVP J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

55566220000 DDAVP J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

43598093111 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

43598093109 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

16714001501 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

00703505401 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

00703505103 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

00703505101 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

00409226511 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

00409226501 DESMOPRESSIN ACETATE J2597 INJ DESMOPRESSIN ACETATE 11/1/2019 12/31/2299

63323001230 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001217 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

63323001211 OXYTOCIN J2590 OXYTOCIN INJECTION 11/1/2019 12/31/2299

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076045038330 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

76045038313 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

72572046210 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

72572046201 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

72572046101 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

72572046001 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

71839010601 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

71839010501 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70700017223 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70700017222 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70700017123 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70700017122 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70121147907 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70121147901 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70121147807 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

70121147801 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

63323041536 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

63323041510 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

63323041336 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

63323041310 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

43598052936 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

43598052911 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

43598052836 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

43598052811 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

42023018910 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

42023018901 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

42023018810 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

42023018801 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00703270403 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00641615010 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00641615001 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00641614910 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00641614901 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00548960200 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00548960100 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00517113405 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00517113401 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00517113305 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

00517113301 NEOSTIGMINE METHYLSULFATE J2710 NEOSTIGMINE METHYLSLFTE INJ 11/1/2019 12/31/2299

72572058510 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

72572058501 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

72572058420 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

72572058401 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

72572058310 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

72572058301 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

65219080010 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

65219080001 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323029730 PROPOVEN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323027065 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323027050 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323027025 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026994 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026978 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026977 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026970 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026969 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026967 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026965 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026959 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026957 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026950 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026937 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026929 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

63323026910 DIPRIVAN J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598054952 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598054910 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598054850 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598054821 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598026558 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598026525 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

43598026520 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

25021060851 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

25021060850 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

25021060820 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00703285801 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619610 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619601 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619520 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619501 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619410 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00641619401 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00591213695 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00591213680 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00591213668 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00591213657 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

00591213655 PROPOFOL J2704 INJ, PROPOFOL, 10 MG 11/1/2019 12/31/2299

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070257033051 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257033011 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257031051 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257031004 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257030051 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257030013 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

44206030090 RHOPHYLAC J2791 RHOPHYLAC INJECTION 11/1/2019 12/31/2299

44206030010 RHOPHYLAC J2791 RHOPHYLAC INJECTION 11/1/2019 12/31/2299

44206030001 RHOPHYLAC J2791 RHOPHYLAC INJECTION 11/1/2019 12/31/2299

13533066160 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533066106 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063120 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063111 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063110 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063103 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533063102 HYPERRHO S-D J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780625 MICRHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780605 MICRHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780601 MICRHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780600 MICRHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780525 RHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780505 RHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780501 RHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

00562780500 RHOGAM ULTRA-FILTERED PLUS J2790 RHO D IMMUNE GLOBULIN INJ 11/1/2019 12/31/2299

13533066160 HYPERRHO S-D J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

13533066106 HYPERRHO S-D J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

00562780625 MICRHOGAM ULTRA-FILTERED PLUS J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

00562780605 MICRHOGAM ULTRA-FILTERED PLUS J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

00562780601 MICRHOGAM ULTRA-FILTERED PLUS J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

00562780600 MICRHOGAM ULTRA-FILTERED PLUS J2788 RHO D IMMUNE GLOBULIN 50 MCG 11/1/2019 12/31/2299

59310061033 CINQAIR J2786 INJECTION, RESLIZUMAB, 1MG 11/1/2019 12/31/2299

59310061031 CINQAIR J2786 INJECTION, RESLIZUMAB, 1MG 11/1/2019 12/31/2299

00469650189 LEXISCAN J2785 REGADENOSON INJECTION 11/1/2019 12/31/2299

00024515175 ELITEK J2783 RASBURICASE 11/1/2019 12/31/2299

00024515011 ELITEK J2783 RASBURICASE 11/1/2019 12/31/2299

00024515010 ELITEK J2783 RASBURICASE 11/1/2019 12/31/2299

70710155001 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

68382042306 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

68382042202 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

67457039862 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

67457039799 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

67457039720 RANITIDINE HCL J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

52565010201 ZANTAC J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

52565010110 ZANTAC J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

52565010101 ZANTAC J2780 RANITIDINE HYDROCHLORIDE INJ 11/1/2019 12/31/2299

50242008288 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008287 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008203 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008202 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008088 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008086 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008003 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

50242008002 LUCENTIS J2778 RANIBIZUMAB INJECTION 11/1/2019 12/31/2299

61570026010 SYNERCID J2770 QUINUPRISTIN/DALFOPRISTIN 11/1/2019 12/31/2299

61570026001 SYNERCID J2770 QUINUPRISTIN/DALFOPRISTIN 11/1/2019 12/31/2299

76045010120 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

23155024041 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

23155024031 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00703450284 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00703450281 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00703450204 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00703450201 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409341461 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409341418 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409341401 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

00409217332 METOCLOPRAMIDE HCL J2765 METOCLOPRAMIDE HCL INJECTION 11/1/2019 12/31/2299

68094010120 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

68094010110 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

51224001220 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

51224001210 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

00143956410 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

00143956401 PHENTOLAMINE MESYLATE J2760 PHENTOLAINE MESYLATE INJ 11/1/2019 12/31/2299

60977014127 PROTOPAM CHLORIDE J2730 PRALIDOXIME CHLORIDE INJ 11/1/2019 12/31/2299

60977014101 PROTOPAM CHLORIDE J2730 PRALIDOXIME CHLORIDE INJ 11/1/2019 12/31/2299

00944417910 CEPROTIN J2724 PROTEIN C CONCENTRATE 11/1/2019 12/31/2299

00944417705 CEPROTIN J2724 PROTEIN C CONCENTRATE 11/1/2019 12/31/2299

00944417510 CEPROTIN J2724 PROTEIN C CONCENTRATE 11/1/2019 12/31/2299

00944417505 CEPROTIN J2724 PROTEIN C CONCENTRATE 11/1/2019 12/31/2299

63323022995 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022994 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022941 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022935 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022930 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022921 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022915 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

63323022905 PROTAMINE SULFATE J2720 INJ PROTAMINE SULFATE/10 MG 11/1/2019 12/31/2299

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063323028630 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028627 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028623 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028620 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028611 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028605 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028600 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028573 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028568 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028567 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028565 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028564 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028559 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028557 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028555 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028553 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028551 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028528 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028523 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028520 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028513 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028510 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028507 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028503 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150020120 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150020010 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150019920 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150019830 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150019720 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150019699 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

55150019520 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066002710 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066002701 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066002310 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066002301 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066001910 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066001901 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066001510 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

43066001501 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

25021065287 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

25021065282 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

17478008292 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

17478008290 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

17478008130 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930321 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930320 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930311 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930310 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930221 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930220 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930131 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930130 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930021 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930020 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930011 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00409930010 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086859 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086852 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086851 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086841 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086759 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086752 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086751 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086744 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086741 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186086362 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186085959 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186085952 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00186085951 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00143926310 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

00143926301 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

50458030911 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030901 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030811 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030801 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030711 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030701 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030611 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

50458030601 RISPERDAL CONSTA J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

12496012001 PERSERIS J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

12496009001 PERSERIS J2794 INJ RISPERDAL CONSTA, 0.5 MG 11/1/2019 12/31/2299

61755000101 ARCALYST J2793 RILONACEPT INJECTION 11/1/2019 12/31/2299

70504310002 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70504310001 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257035051 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

70257035002 WINRHO SDF J2792 RHO(D) IMMUNE GLOBULIN H, SD 11/1/2019 12/31/2299

Page 54: NDC - Procedure Code Crosswalk - Kentucky

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000002733511 HUMATROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

70121100105 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

70121100101 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

63323026530 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

63323025803 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

25021081030 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

25021080810 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00409321805 A-METHAPRED J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00143985101 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00143985001 METHYLPREDNISOLONE SODIUM SUCC J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009085001 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009075801 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009069802 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009069801 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004727 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004726 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004725 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004722 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004704 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009004703 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009001820 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009000302 SOLU-MEDROL J2930 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

70121100005 METHYLPREDNISOLONE SODIUM SUCC J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

70121100001 METHYLPREDNISOLONE SODIUM SUCC J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

63323025503 METHYLPREDNISOLONE SODIUM SUCC J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

25021080705 METHYLPREDNISOLONE SODIUM SUCC J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00409321705 A-METHAPRED J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003933 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003932 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003930 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003928 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003906 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00009003905 SOLU-MEDROL J2920 METHYLPREDNISOLONE INJECTION 11/1/2019 12/31/2299

00143957010 SOD FERRIC GLUCONATE COMPLEX J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00143957001 SOD FERRIC GLUCONATE COMPLEX J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00143929810 SOD FERRIC GLUCONATE COMPLEX J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00143929801 SOD FERRIC GLUCONATE COMPLEX J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00024279410 FERRLECIT J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00024279210 FERRLECIT J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

00024279201 FERRLECIT J2916 NA FERRIC GLUCONATE COMPLEX 11/1/2019 12/31/2299

73090042101 SYLVANT J2860 INJECTION, SILTUXIMAB 11/1/2019 12/31/2299

73090042001 SYLVANT J2860 INJECTION, SILTUXIMAB 11/1/2019 12/31/2299

57894042101 SYLVANT J2860 INJECTION, SILTUXIMAB 11/1/2019 12/31/2299

57894042001 SYLVANT J2860 INJECTION, SILTUXIMAB 11/1/2019 12/31/2299

25682000701 KANUMA J2840 INJ SEBELIPASE ALFA 1 MG 11/1/2019 12/31/2299

71837584305 LEUKINE J2820 SARGRAMOSTIM INJECTION 11/1/2019 12/31/2299

71837584301 LEUKINE J2820 SARGRAMOSTIM INJECTION 11/1/2019 12/31/2299

00024584305 LEUKINE J2820 SARGRAMOSTIM INJECTION 11/1/2019 12/31/2299

00024584301 LEUKINE J2820 SARGRAMOSTIM INJECTION 11/1/2019 12/31/2299

00409770562 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00409767713 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00409766823 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00409766662 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00409766509 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00409766503 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00338044541 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00338044402 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00338044348 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00338043904 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

00264955400 THEOPHYLLINE IN 5% DEXTROSE J2810 INJ THEOPHYLLINE PER 40 MG 11/1/2019 12/31/2299

12496012001 PERSERIS J2798 INJ., PERSERIS, 0.5 MG 11/1/2019 12/31/2299

12496009001 PERSERIS J2798 INJ., PERSERIS, 0.5 MG 11/1/2019 12/31/2299

55513022301 NPLATE J2796 ROMIPLOSTIM INJECTION 11/1/2019 12/31/2299

55513022201 NPLATE J2796 ROMIPLOSTIM INJECTION 11/1/2019 12/31/2299

55513022101 NPLATE J2796 ROMIPLOSTIM INJECTION 11/1/2019 12/31/2299

70069006401 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

67457087720 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

67457087700 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

67457087630 ROPIVACAINE HCL J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028829 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028827 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028821 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028820 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028811 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028810 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028807 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028803 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028721 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028720 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028703 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028695 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028693 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028663 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028638 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028635 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

63323028631 NAROPIN J2795 ROPIVACAINE HCL INJECTION 11/1/2019 12/31/2299

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000093201312 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

72572017201 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

72572017125 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

72572017101 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

72572017025 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

72572017001 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080650 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080620 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080614 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080613 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080612 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080611 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080605 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080602 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

63323080601 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

17478003055 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

17478003025 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

17478003005 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

17478003002 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641603001 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602925 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602901 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602825 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602801 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602725 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00641602701 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909461 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909441 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909431 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909428 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909425 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909422 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909418 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909417 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909416 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909412 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909345 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909337 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909335 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409909332 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409127632 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

00409127603 FENTANYL CITRATE J3010 FENTANYL CITRATE INJECTION 11/1/2019 12/31/2299

39822070602 STREPTOMYCIN SULFATE J3000 STREPTOMYCIN INJECTION 11/1/2019 12/31/2299

50242008527 ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

50242008525 ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

50242004413 ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

50242004406 ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

50242004164 CATHFLO ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

50242004110 CATHFLO ACTIVASE J2997 ALTEPLASE RECOMBINANT 11/1/2019 12/31/2299

10122014301 RETAVASE J2993 RETEPLASE INJECTION 11/1/2019 12/31/2299

10122014102 RETAVASE J2993 RETEPLASE INJECTION 11/1/2019 12/31/2299

55566190201 ZOMACTON J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

55566190101 ZOMACTON J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

55566180101 ZOMACTON J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

50242007501 NUTROPIN AQ NUSPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087338807 ZORBTIVE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087108801 SAIZEN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087100502 SAIZEN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000607 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000601 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000507 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000501 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000407 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

44087000401 SEROSTIM J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00781401471 OMNITROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00781400436 OMNITROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00781300407 OMNITROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00781300107 OMNITROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00169777411 NORDITROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00169770521 NORDITROPIN FLEXPRO J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00169770321 NORDITROPIN FLEXPRO J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265802 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265702 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265602 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265502 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265402 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265302 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265202 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265102 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013265002 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013264902 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013264681 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00013262681 GENOTROPIN J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00002814901 HUMATROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00002814801 HUMATROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

00002814701 HUMATROPE J2941 SOMATROPIN INJECTION 11/1/2019 12/31/2299

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063323096010 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

60505609801 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

60505609800 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

55150022810 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

16729036468 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

16729036403 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00781348192 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00781348170 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00008499420 TYGACIL J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00008499419 TYGACIL J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00008499020 TYGACIL J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

00008499019 TYGACIL J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

75987013015 TEPEZZA J3241 INJ. TEPROTUMUMAB-TRBW 10 MG 10/1/2020 12/31/2299

58468003002 THYROGEN J3240 THYROTROPIN INJECTION 11/1/2019 12/31/2299

58468003001 THYROGEN J3240 THYROTROPIN INJECTION 11/1/2019 12/31/2299

55150031925 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

55150031901 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

55150031825 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

55150031801 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

00641139835 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

00641139831 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

00641139735 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

00641139731 CHLORPROMAZINE HCL J3230 CHLORPROMAZINE HCL INJECTION 11/1/2019 12/31/2299

67979051143 AVEED J3145 TESTOSTERONE UNDECANOATE 1MG 11/1/2019 12/31/2299

54436027504 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

54436027502 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

54436025004 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

54436025002 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

54436020004 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

54436020002 XYOSTED J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

00591322126 TESTOSTERONE ENANTHATE J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

00143975001 TESTOSTERONE ENANTHATE J3121 INJ TESTOSTERO ENANTHATE 1MG 11/1/2019 12/31/2299

55513088002 EVENITY (2 SYRINGES) J3111 INJ. ROMOSOZUMAB-AQQG 1 MG 11/1/2019 12/31/2299

55513088001 EVENITY J3111 INJ. ROMOSOZUMAB-AQQG 1 MG 11/1/2019 12/31/2299

47781065289 TERIPARATIDE J3110 TERIPARATIDE INJECTION 4/1/2020 12/31/2299

00002840001 FORTEO J3110 TERIPARATIDE INJECTION 11/1/2019 12/31/2299

70860080141 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

70860080101 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

63323066501 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

00143974610 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

00143974601 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

00143937510 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

00143937501 TERBUTALINE SULFATE J3105 TERBUTALINE SULFATE INJ 11/1/2019 12/31/2299

62847000101 VIBATIV J3095 TELAVANCIN INJECTION 11/1/2019 12/31/2299

67919004001 SIVEXTRO J3090 INJ TEDIZOLID PHOSPHATE 11/1/2019 12/31/2299

00069010601 ELELYSO J3060 INJ, TALIGLUCERASE ALFA 10 U 11/1/2019 12/31/2299

67386013051 VYEPTI J3032 INJ. EPTINEZUMAB-JJMR 1 MG 10/1/2020 12/31/2299

51759020411 AJOVY SYRINGE J3031 INJ., FREMANEZUMAB-VFRM 1 MG 11/1/2019 12/31/2299

51759020410 AJOVY SYRINGE J3031 INJ., FREMANEZUMAB-VFRM 1 MG 11/1/2019 12/31/2299

51759020222 AJOVY AUTOINJECTOR J3031 INJ., FREMANEZUMAB-VFRM 1 MG 4/1/2020 12/31/2299

51759020211 AJOVY AUTOINJECTOR J3031 INJ., FREMANEZUMAB-VFRM 1 MG 4/1/2020 12/31/2299

51759020210 AJOVY AUTOINJECTOR J3031 INJ., FREMANEZUMAB-VFRM 1 MG 4/1/2020 12/31/2299

67457088005 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

67457088000 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

67457087905 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

67457087900 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

66993008498 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

66993008479 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

66993008398 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

66993008379 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

64679072808 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

64679072801 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

63323027301 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

55150017305 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

55150017301 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

55111069312 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

55111069305 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

47335027641 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

47335027640 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

27505000200 ALSUMA J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781317471 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781317414 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781317307 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781317207 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781317007 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00781316907 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00173073902 IMITREX J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00173073900 IMITREX J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00173047900 IMITREX J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00173047800 IMITREX J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00173044902 IMITREX J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00143963805 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00143963801 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00093201434 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00093201412 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

00093201334 SUMATRIPTAN SUCCINATE J3030 SUMATRIPTAN SUCCINATE / 6 MG 11/1/2019 12/31/2299

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11/18/2020

11/18/2020

11/18/2020

11/18/202000023590412 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

00023590411 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

00023590204 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

00023590203 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

70801000301 ZILRETTA J3304 INJ TRIAMCINOLONE ACE XR 1MG 11/1/2019 12/31/2299

70801000101 ZILRETTA J3304 INJ TRIAMCINOLONE ACE XR 1MG 11/1/2019 12/31/2299

72603040101 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

72603020201 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

72603010801 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165701 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165501 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165401 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165301 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165201 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165105 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121165101 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121116901 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121116801 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121104905 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121104902 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

70121104901 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

16714015001 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

16714014001 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

16714013025 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

16714013001 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00781324572 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00781324375 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00703024501 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00703024301 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00703024101 TRIAMCINOLONE ACETONIDE J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00003049420 KENALOG-10 J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00003029328 KENALOG-40 J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00003029320 KENALOG-40 J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00003029305 KENALOG-40 J3301 TRIAMCINOLONE ACET INJ NOS 11/1/2019 12/31/2299

00065054301 TRIESENCE J3300 TRIAMCINOLONE A INJ PRS-FREE 11/1/2019 12/31/2299

66302011001 REMODULIN J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

66302010501 REMODULIN J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

66302010201 REMODULIN J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

66302010101 REMODULIN J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

42023020901 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

42023020801 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

42023020701 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

42023020601 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00781343080 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00781342780 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00781342580 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00781342080 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00703069601 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00703068601 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00703067601 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

00703066601 TREPROSTINIL J3285 TREPROSTINIL INJECTION 11/1/2019 12/31/2299

50242014301 ACTEMRA ACTPEN J3262 TOCILIZUMAB INJECTION 11/1/2019 12/31/2299

50242013701 ACTEMRA J3262 TOCILIZUMAB INJECTION 11/1/2019 12/31/2299

50242013601 ACTEMRA J3262 TOCILIZUMAB INJECTION 11/1/2019 12/31/2299

50242013501 ACTEMRA J3262 TOCILIZUMAB INJECTION 11/1/2019 12/31/2299

67457047322 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

67457047300 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

67457042830 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

67457042800 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030751 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030630 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030626 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030602 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030502 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030355 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323030351 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

39822041206 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

39822041201 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

36000024425 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

36000024401 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

36000024201 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409359002 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409357811 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409357801 TOBRAMYCIN SULFATE J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409346913 TOBRAMYCIN SULFATE IN NS J3260 TOBRAMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

42023011925 TIGAN J3250 TRIMETHOBENZAMIDE HCL INJ 11/1/2019 12/31/2299

42023011801 TIGAN J3250 TRIMETHOBENZAMIDE HCL INJ 11/1/2019 12/31/2299

25208000202 AGGRASTAT J3246 TIROFIBAN HCL 11/1/2019 12/31/2299

25208000201 AGGRASTAT J3246 TIROFIBAN HCL 11/1/2019 12/31/2299

47335017795 ILUMYA J3245 INJ., TILDRAKIZUMAB, 1 MG 11/1/2019 12/31/2299

47335017710 ILUMYA J3245 INJ., TILDRAKIZUMAB, 1 MG 11/1/2019 12/31/2299

47335017701 ILUMYA J3245 INJ., TILDRAKIZUMAB, 1 MG 11/1/2019 12/31/2299

70594003502 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

70594003501 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

70121164707 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

70121164701 TIGECYCLINE J3243 TIGECYCLINE INJECTION 11/1/2019 12/31/2299

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067457034001 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457034000 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457033950 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457033900 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323031468 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323031466 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323031461 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323029566 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323029561 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323028445 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323028441 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323028421 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323028420 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323022148 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323022143 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323022138 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323022133 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323020341 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323020326 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323020320 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

63323020301 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

55150020420 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

51991094199 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

51991094117 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

51991094099 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

51991094017 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

47781059891 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

47781059807 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

47781059791 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

47781059707 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

25021015899 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

25021015799 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653511 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653501 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653411 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653401 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653361 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653359 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653331 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653311 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653301 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653112 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409653102 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409651001 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409650949 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409650901 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409433211 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00409433201 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338358301 VANCOMYCIN HCL-0.9% NACL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338358201 VANCOMYCIN HCL-0.9% NACL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338358101 VANCOMYCIN HCL-0.9% NACL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338358048 VANCOMYCIN J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338355248 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00338355148 VANCOMYCIN HCL-D5W J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00143935901 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00143935801 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00143935510 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

00143935501 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

72572014002 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

72572014001 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

69339013705 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

69339013701 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

69339013632 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

69339013602 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00409321312 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00409321311 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00409321302 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00409127332 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00409127303 DIAZEPAM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

00004193306 VALIUM J3360 DIAZEPAM INJECTION 11/1/2019 12/31/2299

57894005427 STELARA J3358 USTEKINUMAB, IV INJECT, 1 MG 11/1/2019 12/31/2299

57894006103 STELARA J3357 USTEKINUMAB SUB CU INJ, 1 MG 11/1/2019 12/31/2299

57894006003 STELARA J3357 USTEKINUMAB SUB CU INJ, 1 MG 11/1/2019 12/31/2299

57894006002 STELARA J3357 USTEKINUMAB SUB CU INJ, 1 MG 11/1/2019 12/31/2299

24338015020 TRIPTODUR J3316 INJ., TRIPTORELIN XR 3.75 MG 11/1/2019 12/31/2299

24338015001 TRIPTODUR J3316 INJ., TRIPTORELIN XR 3.75 MG 11/1/2019 12/31/2299

74676590601 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

74676590600 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

74676590401 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

74676590400 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

74676590201 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

74676590200 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

24338015020 TRIPTODUR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

24338015001 TRIPTODUR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

00023590623 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

00023590622 TRELSTAR J3315 TRIPTORELIN PAMOATE 11/1/2019 12/31/2299

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070069017110 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

70069017101 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

70069000510 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

70069000501 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680012130 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680012105 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680011399 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680011225 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680011210 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

69680011201 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

67457040031 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

67457040005 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

67457039925 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

67457039910 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

63323004444 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

63323004441 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

63323004401 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

63323004400 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00517013001 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00517003225 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00517003201 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00517003125 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00517003101 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143962125 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143962101 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143962010 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143962001 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143961910 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

00143961901 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

63323018001 PYRIDOXINE HCL J3415 PYRIDOXINE HCL 100 MG 11/1/2019 12/31/2299

63323018000 PYRIDOXINE HCL J3415 PYRIDOXINE HCL 100 MG 11/1/2019 12/31/2299

67457019602 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

67457019600 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001341 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001326 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001321 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001309 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001302 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

63323001301 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

25021050002 THIAMINE HCL J3411 THIAMINE HCL 100 MG 11/1/2019 12/31/2299

00517560225 HYDROXYZINE HCL J3410 HYDROXYZINE HCL INJECTION 11/1/2019 12/31/2299

00517560125 HYDROXYZINE HCL J3410 HYDROXYZINE HCL INJECTION 11/1/2019 12/31/2299

00517420125 HYDROXYZINE HCL J3410 HYDROXYZINE HCL INJECTION 11/1/2019 12/31/2299

71394041501 LUXTURNA J3398 INJ LUXTURNA 1 BILLION VEC G 11/1/2019 12/31/2299

71394006501 LUXTURNA J3398 INJ LUXTURNA 1 BILLION VEC G 11/1/2019 12/31/2299

69794000101 MEPSEVII J3397 INJ., VESTRONIDASE ALFA-VJBK 11/1/2019 12/31/2299

00187560015 VISUDYNE J3396 VERTEPORFIN INJECTION 11/1/2019 12/31/2299

54092070104 VPRIV J3385 VELAGLUCERASE ALFA 11/1/2019 12/31/2299

64764030020 ENTYVIO J3380 INJECTION, VEDOLIZUMAB 11/1/2019 12/31/2299

72572080501 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

72572080301 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

72572080102 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

72572080101 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70860010541 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70860010520 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70860010441 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70860010410 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004801 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004602 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004601 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004302 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004301 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004203 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004201 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004103 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70594004101 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70436002182 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

70436002082 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001040775 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001040673 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001033964 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001033963 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001033862 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

68001033861 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457082399 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457082312 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457070575 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457070500 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061410 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061310 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061220 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061200 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061110 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457061100 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457034210 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

67457034105 VANCOMYCIN HCL J3370 VANCOMYCIN HCL INJECTION 11/1/2019 12/31/2299

Page 60: NDC - Procedure Code Crosswalk - Kentucky

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000338069104 POTASSIUM CHL-NORMAL SALINE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338069103 POTASSIUM CHL-NORMAL SALINE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338065568 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338031702 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00264786500 POTASSIUM CHL-NORMAL SALINE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00264194020 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

67457056700 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

67457055400 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

67457055300 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323064250 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323064220 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010826 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010802 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010801 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010800 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010705 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010701 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010626 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010615 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010610 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010605 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010603 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010602 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010601 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323010600 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006443 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006441 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006429 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006423 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006421 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006411 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006410 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006404 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006403 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

63323006401 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

51754100004 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

51754100001 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

44567042124 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

44567042100 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

44567042024 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

44567042000 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

44567041024 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409673013 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409673011 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672941 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672931 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672924 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672923 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672921 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672911 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672909 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672903 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672723 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409672711 MAGNESIUM SULFATE-D5W J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409216802 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409175415 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

00409175410 MAGNESIUM SULFATE J3475 INJ MAGNESIUM SULFATE 11/1/2019 12/31/2299

18657011704 HYLENEX J3473 HYALURONIDASE RECOMBINANT 11/1/2019 12/31/2299

18657011702 HYLENEX J3473 HYALURONIDASE RECOMBINANT 11/1/2019 12/31/2299

18657011701 HYLENEX J3473 HYALURONIDASE RECOMBINANT 11/1/2019 12/31/2299

24208000202 VITRASE J3471 OVINE, UP TO 999 USP UNITS 11/1/2019 12/31/2299

00548909010 AMPHADASE J3470 HYALURONIDASE INJECTION 11/1/2019 12/31/2299

72266013101 VORICONAZOLE J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

70436002980 VORICONAZOLE J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

47781046671 VORICONAZOLE J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

39822107701 VORICONAZOLE J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

00781341694 VORICONAZOLE J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

00049419001 VFEND IV J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

00049319038 VFEND IV J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

00049319028 VFEND IV J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

00049319001 VFEND IV J3465 INJECTION, VORICONAZOLE 11/1/2019 12/31/2299

13533081051 XEMBIFY J3450 MEPHENTERMINE SULFATE INJ 11/1/2019 12/31/2299

13533081050 XEMBIFY J3450 MEPHENTERMINE SULFATE INJ 11/1/2019 12/31/2299

76329124001 PHYTONADIONE J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

43598040516 PHYTONADIONE J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

43598040511 PHYTONADIONE J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915855 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915850 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915831 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915811 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915801 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915750 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915731 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

00409915701 VITAMIN K1 J3430 VITAMIN K PHYTONADIONE INJ 11/1/2019 12/31/2299

70069017210 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

70069017201 CYANOCOBALAMIN INJECTION J3420 VITAMIN B12 INJECTION 11/1/2019 12/31/2299

Page 61: NDC - Procedure Code Crosswalk - Kentucky

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03/06/2020

03/06/2020

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059630026601 FETROJA J3490 DRUGS UNCLASSIFIED INJECTION 1/1/2020 12/31/2299

51754010803 TRANEXAMIC ACID-NACL J3490 DRUGS UNCLASSIFIED INJECTION 1/1/2020 12/31/2299

51754010801 TRANEXAMIC ACID-NACL J3490 DRUGS UNCLASSIFIED INJECTION 1/1/2020 12/31/2299

46287002415 POTASSIUM PHOSPHATES J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

46287002410 POTASSIUM PHOSPHATES J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

42023017204 MYCOPHENOLATE MOFETIL J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

17478095740 MYCOPHENOLATE MOFETIL J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

17478042240 MYCOPHENOLATE MOFETIL J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

00004029830 CELLCEPT J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

00004029809 CELLCEPT J3490 DRUGS UNCLASSIFIED INJECTION 7/1/2020 12/31/2299

70860080282 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

70860021051 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

68001043725 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

68001036625 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

68001036622 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

67457092005 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

67457079410 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

67457061910 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

67457039054 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

63323096600 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

63323096198 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

55150026605 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

55111068852 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

55111068507 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

51991006598 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

51991006498 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

50742041605 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

47335096241 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

47335003540 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

43598033111 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

43598033011 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

25021083082 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

25021082682 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

25021082667 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

25021080166 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

23155018631 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

23155017031 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

16729024231 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

16714081501 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

00409422901 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

00409422801 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

00409421505 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

00409421501 ZOLEDRONIC ACID J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

00078043561 RECLAST J3489 ZOLEDRONIC ACID 1MG 11/1/2019 12/31/2299

72266016042 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

72266016041 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

72266016010 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

72266016001 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

43598084858 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

43598084811 ZIPRASIDONE MESYLATE J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

00049392083 GEODON J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

00049392020 GEODON J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

00049120310 GEODON J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

00049120301 GEODON J3486 ZIPRASIDONE MESYLATE 11/1/2019 12/31/2299

49702021326 RETROVIR J3485 ZIDOVUDINE 11/1/2019 12/31/2299

49702021301 RETROVIR J3485 ZIDOVUDINE 11/1/2019 12/31/2299

63323096730 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096701 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096520 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096510 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096505 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096503 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096502 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

63323096501 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990925739 POTASSIUM CHLORIDE-NACL J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990711509 POTASSIUM CHL-NORMAL SALINE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990707726 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990707714 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990707526 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990707514 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00990707426 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409707726 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409707626 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409665318 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409665305 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409665119 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409665106 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409663518 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409663501 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00409390703 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070948 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070548 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070541 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070434 POTASSIUM CHLORIDE-NACL J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070348 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

00338070341 POTASSIUM CHLORIDE J3480 INJ POTASSIUM CHLORIDE 11/1/2019 12/31/2299

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000338958396 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338957996 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338956760 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954306 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954304 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954302 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338630404 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338005144 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338005047 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004948 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004941 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004938 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004931 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004918 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004911 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004910 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004904 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004903 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004902 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004901 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004805 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004804 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004803 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004802 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004747 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004746 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004744 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004729 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004727 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004512 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004511 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004504 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004503 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004502 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004501 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999910 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999900 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780020 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780010 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780009 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780001 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780000 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264738860 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264738850 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220170 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220150 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220110 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220100 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180036 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180032 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180031 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

71274035002 RUCONEST J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

71274035001 RUCONEST J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

68982081086 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081085 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081084 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081083 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081082 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081081 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081006 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081005 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081004 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081003 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081002 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68982081001 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

68012035002 RUCONEST J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

68012035001 RUCONEST J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

63833082902 HAEGARDA J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

63833082802 HAEGARDA J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

62064024130 EGRIFTA SV J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

57894064001 TREMFYA J3590 UNCLASSIFIED BIOLOGICS 11/1/2019 12/31/2299

50242000701 ENSPRYNG J3590 UNCLASSIFIED BIOLOGICS 7/1/2020 12/31/2299

00069196502 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069196501 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069150902 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069150901 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069147602 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069147601 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069106102 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00069106101 CUTAQUIG J3590 UNCLASSIFIED BIOLOGICS 1/1/2020 12/31/2299

00024591502 DUPIXENT PEN J3590 UNCLASSIFIED BIOLOGICS 7/1/2020 12/31/2299

00024591500 DUPIXENT PEN J3590 UNCLASSIFIED BIOLOGICS 7/1/2020 12/31/2299

72152054720 ZULRESSO J3490 DRUGS UNCLASSIFIED INJECTION 1/1/2020 12/31/2299

62935015450 FENSOLVI J3490 DRUGS UNCLASSIFIED INJECTION 4/1/2020 12/31/2299

62935015350 FENSOLVI J3490 DRUGS UNCLASSIFIED INJECTION 4/1/2020 12/31/2299

59630026610 FETROJA J3490 DRUGS UNCLASSIFIED INJECTION 1/1/2020 12/31/2299

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000338004911 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004910 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004904 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004903 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004902 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004901 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004805 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004804 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004803 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004802 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004747 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004746 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004744 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004729 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004727 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004512 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004511 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004504 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004503 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004502 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004501 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999910 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999900 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780020 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780010 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780009 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780001 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780000 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264738860 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264738850 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220170 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220150 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220110 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264220100 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180036 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180032 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180031 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062376 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062375 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062374 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062361 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062359 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062357 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062353 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062351 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062350 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062310 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062309 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062300 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798437 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798436 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798423 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798420 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798413 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798411 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798406 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798361 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798355 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798325 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798309 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798303 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798302 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797208 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797207 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797205 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990713836 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990713809 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990613822 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990613803 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798411 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798406 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798355 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798353 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798303 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409797207 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409713836 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409713809 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710169 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710168 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710167 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710166 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710104 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710102 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409613822 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409613803 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409158301 SODIUM CHLORIDE J7030 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

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000338001710 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001704 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001703 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001702 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001701 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001612 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001511 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001504 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001503 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001501 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761620 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761610 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761600 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761410 DEXTROSE 5%-0.33% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761210 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761200 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761010 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264761000 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264751020 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264751010 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264751000 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264151032 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00264151031 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062376 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062375 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062374 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062361 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062359 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062357 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062353 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062351 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062350 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062310 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062309 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062300 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798437 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798436 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798423 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798420 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798413 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798411 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798406 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798361 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798355 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798325 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798309 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798303 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798302 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797208 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797207 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990797205 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990713836 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990713809 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990613822 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990613803 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798411 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798406 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798355 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798353 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798303 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409797207 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409713836 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409713809 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710169 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710168 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710167 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710166 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710104 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710102 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409613822 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409613803 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409158301 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338958396 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338957996 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338956760 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954306 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954304 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954302 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338630404 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338005144 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338005047 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004948 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004941 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004938 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004931 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004918 SODIUM CHLORIDE J7040 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

Page 65: NDC - Procedure Code Crosswalk - Kentucky

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000264180032 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180031 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062475 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062474 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062461 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062450 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062410 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062407 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062406 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062405 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

63323062404 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990794109 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990794103 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792609 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792603 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792602 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792503 DEXTROSE 5%-0.3% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792409 DEXTROSE 5%-0.225% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792403 DEXTROSE 5%-0.225% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792402 DEXTROSE 5%-0.225% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792337 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792336 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792323 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792320 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792313 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792311 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792306 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792261 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792255 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792225 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792209 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792203 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00990792202 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409794102 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792609 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792603 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792509 DEXTROSE 5%-0.3% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792409 DEXTROSE 5%-0.225% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792336 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792311 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792225 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409792203 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710069 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710068 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710067 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710066 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710004 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409710002 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409152301 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409152203 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00409152202 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338957360 GLUCOSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338956948 GLUCOSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338953396 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338953096 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338952772 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338952111 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008904 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008903 DEXTROSE 5%-0.9% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008504 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008503 DEXTROSE 5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008304 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008303 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008302 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338008103 DEXTROSE 5%-0.33% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007904 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007903 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007902 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007704 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007703 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007702 DEXTROSE 5%-0.2% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007504 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007503 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007502 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007304 DEXTROSE 2.5%-0.45% NACL J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007104 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007103 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338007102 DEXTROSE WITH SODIUM CHLORIDE J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338006620 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338006230 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001748 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001741 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001738 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001731 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001718 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

00338001711 DEXTROSE IN WATER J7042 5% DEXTROSE/NORMAL SALINE 11/1/2019 12/31/2299

Page 66: NDC - Procedure Code Crosswalk - Kentucky

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000338001718 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001711 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001710 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001704 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001703 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001702 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001701 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001612 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001511 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001504 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001503 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001501 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00264751020 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00264751010 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00264751000 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00264151032 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00264151031 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062376 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062375 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062374 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062361 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062359 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062357 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062353 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062351 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062350 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062310 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062309 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

63323062300 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798437 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798436 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798423 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798420 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798413 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798411 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798406 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798361 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798355 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798325 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798309 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798303 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00990798302 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798411 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798406 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798355 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798353 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409798303 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710169 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710168 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710167 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710166 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710104 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409710102 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00409158301 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338958396 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338957996 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338956760 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954306 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954304 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338954302 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338630404 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004948 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004941 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004938 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004931 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004918 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004911 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004910 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004904 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004903 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004902 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004901 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004512 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004511 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004504 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004503 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004502 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00338004501 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999910 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264999900 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780020 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780010 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780009 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780001 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264780000 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

00264180036 SODIUM CHLORIDE J7050 NORMAL SALINE SOLUTION INFUS 11/1/2019 12/31/2299

Page 67: NDC - Procedure Code Crosswalk - Kentucky

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06/09/202000409792203 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710069 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710068 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710067 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710066 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710004 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409710002 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409152301 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409152203 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409152202 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338957360 GLUCOSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338956948 GLUCOSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338953396 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338953096 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338952772 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338952111 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338006620 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338006230 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001748 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001741 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001738 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001731 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001718 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001711 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001710 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001704 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001703 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001702 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001701 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001612 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001511 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001504 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001503 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00338001501 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00264751020 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00264751010 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00264751000 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00264151032 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00264151031 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062475 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062474 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062461 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062450 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062410 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062407 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062406 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062405 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

63323062404 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792337 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792336 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792323 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792320 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792313 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792311 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792306 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792261 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792255 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792225 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792209 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792203 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00990792202 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409792336 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409792311 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409792225 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409792203 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710069 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710068 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710067 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710066 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710004 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409710002 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409152301 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409152203 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00409152202 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338957360 GLUCOSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338956948 GLUCOSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338953396 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338953096 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338952772 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338952111 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338006620 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338006230 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001748 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001741 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001738 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

00338001731 DEXTROSE IN WATER J7060 5% DEXTROSE/WATER 11/1/2019 12/31/2299

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000409158603 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00338005603 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00338005503 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00338005403 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00338005303 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00264780610 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00264780510 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

00990792909 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00990792903 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00409792909 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00338012504 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00338012503 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00338012304 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00338012303 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00264775110 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

00264775100 DEXTROSE IN LACTATED RINGERS J7121 5% DEXTROSE IN LAC RINGERS 11/1/2019 12/31/2299

63323016476 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

63323016475 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

63323016474 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

63323016426 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

63323016425 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

63323016424 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00990795309 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00990795302 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00990792909 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00990792903 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409795330 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409795309 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409795303 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409795302 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409792909 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409614009 RINGERS IRRIGATION J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338630704 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338018944 TIS-U-SOL J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338018904 TIS-U-SOL J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338018902 TIS-U-SOL J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338012504 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338012503 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338012304 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338012303 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011704 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011703 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011702 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011304 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011303 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338011302 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00338010404 RINGERS IRRIGATION J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264775110 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264775100 DEXTROSE IN LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264775020 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264775010 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264775000 LACTATED RINGERS J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00264220200 RINGERS IRRIGATION J7120 RINGERS LACTATE INFUSION 11/1/2019 12/31/2299

00409150503 DEXTRAN 70 IN NORMAL SALINE J7110 DEXTRAN 75 INFUSION 11/1/2019 12/31/2299

00338026303 GENTRAN 75 IN NORMAL SALINE J7110 DEXTRAN 75 INFUSION 11/1/2019 12/31/2299

00409741914 LMD 10% WITH 0.9% SOD CHLORIDE J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

00409741903 LMD 10% WITH 0.9% SOD CHLORIDE J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

00409741813 LMD 10% WITH 5% DEXTROSE J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

00409741803 LMD 10% WITH 5% DEXTROSE J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

00338027103 GENTRAN 40 IN DEXTROSE 5% J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

00338026903 GENTRAN 40 IN NORMAL SALINE J7100 DEXTRAN 40 INFUSION 11/1/2019 12/31/2299

63323062475 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062474 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062461 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062450 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062410 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062407 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062406 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062405 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

63323062404 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792337 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792336 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792323 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792320 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792313 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792311 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792306 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792261 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792255 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792225 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792209 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792203 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00990792202 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409792336 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409792311 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

00409792225 DEXTROSE IN WATER J7070 D5W INFUSION 11/1/2019 12/31/2299

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0

076125067351 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

76125066931 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

76125066830 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

76125025620 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

76125025221 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

68516461402 ALPHANATE J7190 FACTOR VIII 11/1/2019 12/31/2299

68516461201 ALPHANATE J7190 FACTOR VIII 11/1/2019 12/31/2299

68516460802 ALPHANATE J7190 FACTOR VIII 11/1/2019 12/31/2299

68516460601 ALPHANATE J7190 FACTOR VIII 11/1/2019 12/31/2299

68516460201 ALPHANATE J7190 FACTOR VIII 11/1/2019 12/31/2299

00944394602 HEMOFIL M J7190 FACTOR VIII 11/1/2019 12/31/2299

00944394501 HEMOFIL M J7190 FACTOR VIII 11/1/2019 12/31/2299

00944394402 HEMOFIL M J7190 FACTOR VIII 11/1/2019 12/31/2299

00944394202 HEMOFIL M J7190 FACTOR VIII 11/1/2019 12/31/2299

00944394002 HEMOFIL M J7190 FACTOR VIII 11/1/2019 12/31/2299

00053765602 MONOCLATE-P J7190 FACTOR VIII 11/1/2019 12/31/2299

00053765601 MONOCLATE-P J7190 FACTOR VIII 11/1/2019 12/31/2299

00169721211 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00169721111 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00169720801 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00169720501 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00169720201 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00169720101 NOVOSEVEN RT J7189 FACTOR VIIA RECOMB NOVOSEVEN 11/1/2019 12/31/2299

00944500110 OBIZUR J7188 FACTOR VIII RECOMB OBIZUR 11/1/2019 12/31/2299

00944500105 OBIZUR J7188 FACTOR VIII RECOMB OBIZUR 11/1/2019 12/31/2299

00944500101 OBIZUR J7188 FACTOR VIII RECOMB OBIZUR 11/1/2019 12/31/2299

63833062701 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

63833062601 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

63833062501 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

63833061702 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

63833061602 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

63833061502 HUMATE-P J7187 HUMATE-P, INJ 11/1/2019 12/31/2299

68516461502 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516461402 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516461302 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516461201 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516461101 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516461002 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460902 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460802 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460702 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460601 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460501 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460302 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460201 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

68516460101 ALPHANATE J7186 ANTIHEMOPHILIC VIII/VWF COMP 11/1/2019 12/31/2299

58394012503 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394012403 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394012303 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394012203 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394011603 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394011501 XYNTHA J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394002503 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394002403 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394002303 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394002203 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394001603 XYNTHA SOLOFUSE J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394001501 XYNTHA J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394001401 XYNTHA J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394001301 XYNTHA J7185 XYNTHA INJ 11/1/2019 12/31/2299

58394001201 XYNTHA J7185 XYNTHA INJ 11/1/2019 12/31/2299

00169783001 NOVOEIGHT J7182 FACTOR VIII RECOMB NOVOEIGHT 11/1/2019 12/31/2299

00169711311 TRETTEN J7181 FACTOR XIII RECOMB A-SUBUNIT 11/1/2019 12/31/2299

00169701301 TRETTEN J7181 FACTOR XIII RECOMB A-SUBUNIT 11/1/2019 12/31/2299

63833051802 CORIFACT J7180 FACTOR XIII ANTI-HEM FACTOR 11/1/2019 12/31/2299

00944755302 VONVENDI J7179 VONVENDI INJ 1 IU VWF:RCO 11/1/2019 12/31/2299

00944755201 VONVENDI J7179 VONVENDI INJ 1 IU VWF:RCO 11/1/2019 12/31/2299

00944755102 VONVENDI J7179 VONVENDI INJ 1 IU VWF:RCO 11/1/2019 12/31/2299

00944755001 VONVENDI J7179 VONVENDI INJ 1 IU VWF:RCO 11/1/2019 12/31/2299

68982034801 FIBRYGA J7178 INJ HUMAN FIBRINOGEN CON NOS 11/1/2019 12/31/2299

68982034701 FIBRYGA J7178 INJ HUMAN FIBRINOGEN CON NOS 11/1/2019 12/31/2299

63833089190 RIASTAP J7178 INJ HUMAN FIBRINOGEN CON NOS 11/1/2019 12/31/2299

63833089151 RIASTAP J7178 INJ HUMAN FIBRINOGEN CON NOS 11/1/2019 12/31/2299

68982034801 FIBRYGA J7177 INJ., FIBRYGA, 1 MG 11/1/2019 12/31/2299

68982034701 FIBRYGA J7177 INJ., FIBRYGA, 1 MG 11/1/2019 12/31/2299

64208775601 COAGADEX J7175 INJ, FACTOR X, (HUMAN), 1IU 11/1/2019 12/31/2299

64208775401 COAGADEX J7175 INJ, FACTOR X, (HUMAN), 1IU 11/1/2019 12/31/2299

64208775301 COAGADEX J7175 INJ, FACTOR X, (HUMAN), 1IU 11/1/2019 12/31/2299

64208775201 COAGADEX J7175 INJ, FACTOR X, (HUMAN), 1IU 11/1/2019 12/31/2299

50242092301 HEMLIBRA J7170 INJ., EMICIZUMAB-KXWH 0.5 MG 11/1/2019 12/31/2299

50242092201 HEMLIBRA J7170 INJ., EMICIZUMAB-KXWH 0.5 MG 11/1/2019 12/31/2299

50242092101 HEMLIBRA J7170 INJ., EMICIZUMAB-KXWH 0.5 MG 11/1/2019 12/31/2299

50242092001 HEMLIBRA J7170 INJ., EMICIZUMAB-KXWH 0.5 MG 11/1/2019 12/31/2299

69853010201 ANDEXXA J7169 INJ ANDEXXA, 10 MG 7/1/2020 12/31/2299

63323053075 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

63323053021 SODIUM CHLORIDE J7131 HYPERTONIC SALINE SOL 11/1/2019 12/31/2299

Page 70: NDC - Procedure Code Crosswalk - Kentucky

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013533060320 THROMBATE III J7197 ANTITHROMBIN III INJECTION 11/1/2019 12/31/2299

13533060250 THROMBATE III J7197 ANTITHROMBIN III INJECTION 11/1/2019 12/31/2299

58394063703 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394063603 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394063503 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394063403 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394063303 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394013603 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394013403 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

58394013303 BENEFIX J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00944303402 RIXUBIS J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00944303202 RIXUBIS J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00944303002 RIXUBIS J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00944302802 RIXUBIS J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00944302602 RIXUBIS J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169795511 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169792211 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169791111 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169790501 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169790201 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

00169790101 REBINYN J7195 FACTOR IX RECOMBINANT NOS 11/1/2019 12/31/2299

68516320902 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320802 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320701 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320602 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320502 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320401 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320302 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320202 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516320101 PROFILNINE J7194 FACTOR IX COMPLEX 11/1/2019 12/31/2299

68516360902 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360802 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360702 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360602 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360502 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360402 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360302 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516360102 ALPHANINE SD J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516320802 PROFILNINE J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516320502 PROFILNINE J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

68516320202 PROFILNINE J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

00053623302 MONONINE J7193 FACTOR IX NON-RECOMBINANT 11/1/2019 12/31/2299

00944305404 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305403 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305402 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305304 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305303 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305302 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305204 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305203 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305202 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305104 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305103 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944305102 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944304710 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944304611 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944304610 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944304512 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944304510 ADVATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944284510 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944284410 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944284310 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944284210 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944284110 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00944283501 RECOMBINATE J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026482801 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026482601 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026482401 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026482201 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026482101 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026382850 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026382650 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026382425 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026382225 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026382125 KOVALTRY J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026379770 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026379660 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026379550 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026379330 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026379220 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026378775 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026378665 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026378555 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026378335 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

00026378225 KOGENATE FS J7192 FACTOR VIII RECOMBINANT NOS 11/1/2019 12/31/2299

76125067650 KOATE J7190 FACTOR VIII 11/1/2019 12/31/2299

Page 71: NDC - Procedure Code Crosswalk - Kentucky

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000944462602 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462601 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462502 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462501 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462402 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462401 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462302 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462301 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462202 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462201 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

71104081001 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080801 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080701 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080601 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080501 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080401 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080301 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080201 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104080101 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104049208 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104049008 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048908 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048808 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048708 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048608 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048508 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048408 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

71104048308 ELOCTATE J7205 FACTOR VIII FC FUSION RECOMB 11/1/2019 12/31/2299

00169850111 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169850001 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169830111 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169830001 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169820111 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169820001 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169815111 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169815001 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169810111 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169810001 ESPEROCT J7204 INJ RECOMBIN ESPEROCT PER IU 7/1/2020 12/31/2299

00169795511 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

00169792211 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

00169791111 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

00169790501 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

00169790201 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

00169790101 REBINYN J7203 FACTOR IX RECOMB GLY REBINYN 11/1/2019 12/31/2299

69911086902 IDELVION J7202 FACTOR IX IDELVION INJ 11/1/2019 12/31/2299

69911086702 IDELVION J7202 FACTOR IX IDELVION INJ 11/1/2019 12/31/2299

69911086602 IDELVION J7202 FACTOR IX IDELVION INJ 11/1/2019 12/31/2299

69911086502 IDELVION J7202 FACTOR IX IDELVION INJ 11/1/2019 12/31/2299

69911086402 IDELVION J7202 FACTOR IX IDELVION INJ 11/1/2019 12/31/2299

71104097701 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104096601 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095609 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095509 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095409 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095309 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095201 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104095109 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104094401 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104093301 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104092201 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

71104091101 ALPROLIX J7201 FACTOR IX ALPROLIX RECOMB 11/1/2019 12/31/2299

58394063703 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394063603 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394063503 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394063403 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394063303 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394013603 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394013403 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

58394013303 BENEFIX J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00944303402 RIXUBIS J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00944303202 RIXUBIS J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00944303002 RIXUBIS J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00944302802 RIXUBIS J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00944302602 RIXUBIS J7200 FACTOR IX RECOMBINAN RIXUBIS 11/1/2019 12/31/2299

00026494801 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026494601 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026494401 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026494201 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026394825 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026394625 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026394425 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

00026394225 JIVI J7199 HEMOPHILIA CLOT FACTOR NOC 11/1/2019 12/31/2299

64193042502 FEIBA NF J7198 ANTI-INHIBITOR 11/1/2019 12/31/2299

64193032501 FEIBA NF J7198 ANTI-INHIBITOR 11/1/2019 12/31/2299

64193022204 FEIBA VH IMMUNO J7198 ANTI-INHIBITOR 11/1/2019 12/31/2299

13533060521 THROMBATE III J7197 ANTITHROMBIN III INJECTION 11/1/2019 12/31/2299

Page 72: NDC - Procedure Code Crosswalk - Kentucky

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000074301207 DUOPA J7340 CARBIDOPA LEVODOPA ENT 100ML 11/1/2019 12/31/2299

72512092901 QUTENZA J7336 CAPSAICIN 8% PATCH 11/1/2019 12/31/2299

72512092801 QUTENZA J7336 CAPSAICIN 8% PATCH 11/1/2019 12/31/2299

57844018121 SODIUM HYALURONATE J7321 HYALGAN OR SUPARTZ INJ DOSE 11/1/2019 12/31/2299

57844018113 SODIUM HYALURONATE J7321 HYALGAN OR SUPARTZ INJ DOSE 11/1/2019 12/31/2299

71879013601 YUTIQ J7314 INJ., YUTIQ, 0.01 MG 11/1/2019 12/31/2299

68611019002 ILUVIEN J7313 INJ., ILUVIEN, 0.01 MG 11/1/2019 12/31/2299

00023334807 OZURDEX J7312 DEXAMETHASONE INTRA IMPLANT 11/1/2019 12/31/2299

24208041601 RETISERT J7311 INJ., RETISERT, 0.01 MG 11/1/2019 12/31/2299

67308010106 LEVULAN J7308 AMINOLEVULINIC ACID HCL TOP 11/1/2019 12/31/2299

67308010101 LEVULAN J7308 AMINOLEVULINIC ACID HCL TOP 11/1/2019 12/31/2299

00052433001 NEXPLANON J7307 ETONOGESTREL IMPLANT SYSTEM 11/1/2019 12/31/2299

50419042201 SKYLA J7301 SKYLA, 13.5 MG 11/1/2019 12/31/2299

59365512801 PARAGARD T 380-A J7300 INTRAUT COPPER CONTRACEPTIVE 11/1/2019 12/31/2299

50419042301 MIRENA J7298 MIRENA, 52 MG 11/1/2019 12/31/2299

00023585801 LILETTA J7297 LILETTA, 52 MG 11/1/2019 12/31/2299

50419042408 KYLEENA J7296 KYLEENA, 19.5 MG 11/1/2019 12/31/2299

50419042401 KYLEENA J7296 KYLEENA, 19.5 MG 11/1/2019 12/31/2299

00944305304 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305303 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305302 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305204 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305203 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305202 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305104 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305103 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944305102 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944304611 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944304610 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944304512 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00944304510 ADVATE J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026482801 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026482601 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026482401 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026482201 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026482101 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026382850 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026382650 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026382425 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026382225 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026382125 KOVALTRY J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026379770 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026379660 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026379550 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026379330 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026379220 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026378775 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026378665 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026378555 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026378335 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

00026378225 KOGENATE FS J7211 INJ, KOVALTRY, 1 I.U. 11/1/2019 12/31/2299

69911049101 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911049001 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911048102 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911048002 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911047802 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911047702 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911047602 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911047502 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

69911047402 AFSTYLA J7210 INJ, AFSTYLA, 1 I.U. 11/1/2019 12/31/2299

68982015201 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982015101 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982015001 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014901 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014801 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014701 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014601 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014501 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014401 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014301 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014201 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014101 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982014001 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

68982013901 NUWIQ J7209 FACTOR VIII NUWIQ RECOMB 1IU 11/1/2019 12/31/2299

00026494801 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026494601 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026494401 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026494201 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026394825 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026394625 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026394425 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00026394225 JIVI J7208 INJ. JIVI 1 IU 11/1/2019 12/31/2299

00944462802 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462801 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462702 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

00944462701 ADYNOVATE J7207 FACTOR VIII PEGYLATED RECOMB 11/1/2019 12/31/2299

Page 73: NDC - Procedure Code Crosswalk - Kentucky

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069452015320 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68462068601 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68462068501 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68084045111 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68084045101 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68084045011 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

68084045001 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

67877028001 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

67877027901 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

67877027801 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

64380072206 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

64380072106 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

64380072006 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

55111052701 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

55111052601 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

55111052501 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079081820 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079081801 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079081720 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079081701 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079002820 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

51079002801 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

16729004301 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

16729004201 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

16729004101 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00904662461 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00904662361 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00781210401 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00781210301 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00781210201 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00469065773 PROGRAF J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00469061773 PROGRAF J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00469060773 PROGRAF J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00378204701 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00378204601 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00378204501 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

00009722402 ATGAM J7504 LYMPHOCYTE IMMUNE GLOBULIN 11/1/2019 12/31/2299

00009722401 ATGAM J7504 LYMPHOCYTE IMMUNE GLOBULIN 11/1/2019 12/31/2299

68992307503 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68992307501 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68992304003 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68992304001 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68992301003 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68992301001 ENVARSUS XR J7503 TACROL ENVARSUS EX REL ORAL 11/1/2019 12/31/2299

68084092195 CYCLOSPORINE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

68084092125 CYCLOSPORINE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

60505463203 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

60505463103 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

60505013400 CYCLOSPORINE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

51862046047 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

51862046001 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00172731320 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00093574265 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00093574219 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00093574165 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00093574119 CYCLOSPORINE MODIFIED J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078027422 NEORAL J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078024861 NEORAL J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078024815 NEORAL J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078024161 SANDIMMUNE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078024115 SANDIMMUNE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00078011022 SANDIMMUNE J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00074726950 GENGRAF J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00074310932 GENGRAF J7502 CYCLOSPORINE ORAL 100 MG 11/1/2019 12/31/2299

00143956601 AZATHIOPRINE SODIUM J7501 AZATHIOPRINE PARENTERAL 11/1/2019 12/31/2299

68462050201 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

68382000305 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

68382000301 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

68084022911 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

68084022901 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

67877049305 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

67877049301 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

65649024141 AZASAN J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

65649023141 AZASAN J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

54766059010 IMURAN J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

51079062006 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

51079062001 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

00378100501 AZATHIOPRINE J7500 AZATHIOPRINE ORAL 50MG 11/1/2019 12/31/2299

10599000301 SINUVA J7401 MOMETASONE FUROATE SINUS IMP 11/1/2019 12/31/2299

00023965201 DURYSTA J7351 INJ BIMATOPROST ITC IMP1MCG 10/1/2020 12/31/2299

70621010130 AMELUZ J7345 AMINOLEVULINIC ACID, 10% GEL 11/1/2019 12/31/2299

70621010110 AMELUZ J7345 AMINOLEVULINIC ACID, 10% GEL 11/1/2019 12/31/2299

70621010101 AMELUZ J7345 AMINOLEVULINIC ACID, 10% GEL 11/1/2019 12/31/2299

67308010106 LEVULAN J7345 AMINOLEVULINIC ACID, 10% GEL 11/1/2019 12/31/2299

67308010101 LEVULAN J7345 AMINOLEVULINIC ACID, 10% GEL 11/1/2019 12/31/2299

69251020101 OTIPRIO J7342 CIPROFLOXACIN OTIC SUSP 6 MG 11/1/2019 12/31/2299

Page 74: NDC - Procedure Code Crosswalk - Kentucky

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11/02/2020

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02/06/2020

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00054372250 PREDNISONE J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

00054372144 PREDNISONE INTENSOL J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

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50383004248 PREDNISOLONE J7510 PREDNISOLONE ORAL PER 5 MG 11/1/2019 12/31/2299

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23594050550 MILLIPRED J7510 PREDNISOLONE ORAL PER 5 MG 11/1/2019 12/31/2299

23594050501 MILLIPRED J7510 PREDNISOLONE ORAL PER 5 MG 11/1/2019 12/31/2299

13925016604 PREDNISOLONE SODIUM PHOSPHATE J7510 PREDNISOLONE ORAL PER 5 MG 11/1/2019 12/31/2299

00121075908 PREDNISOLONE SODIUM PHOSPHATE J7510 PREDNISOLONE ORAL PER 5 MG 11/1/2019 12/31/2299

72647033104 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

72647033101 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

68382091911 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

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68382091634 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

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68084014901 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

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59762444003 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

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59762005101 METHYLPREDNISOLONE J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

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00009002001 MEDROL J7509 METHYLPREDNISOLONE ORAL 11/1/2019 12/31/2299

68992307503 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

68992307501 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

68992304003 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

68992304001 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

68992301003 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

68992301001 ENVARSUS XR J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

00469068773 ASTAGRAF XL J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

00469067773 ASTAGRAF XL J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

00469064773 ASTAGRAF XL J7508 TACROL ASTAGRAF EX REL ORAL 11/1/2019 12/31/2299

70748022101 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

70748022001 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

70748021901 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

70377001611 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

70377001511 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

70377001411 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

69452015520 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

69452015420 TACROLIMUS J7507 TACROLIMUS IMME REL ORAL 1MG 11/1/2019 12/31/2299

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060505013300 CYCLOSPORINE J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

51862045847 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

51862045801 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00093574165 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00093574119 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00093574065 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00093574019 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00078024661 NEORAL J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00078024615 NEORAL J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00078024061 SANDIMMUNE J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00078024015 SANDIMMUNE J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

00074310832 GENGRAF J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

70954006110 PREDNISONE J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

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00378064110 PREDNISONE J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

00378064101 PREDNISONE J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

00378064010 PREDNISONE J7512 PREDNISONE IR OR DR ORAL 1MG 11/1/2019 12/31/2299

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000008104105 RAPAMUNE J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

00008103006 RAPAMUNE J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

00008103004 RAPAMUNE J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

70748021816 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

70748021716 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

68084091895 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

68084091825 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

68084090721 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

68084090711 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

60505296607 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

60505296507 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

51079050920 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

51079050901 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

51079050820 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

51079050801 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

50268056012 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

50268056011 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

16729026129 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

16729018929 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00904678661 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00904678604 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00904678561 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00904678504 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00378420278 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00378420178 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00093703289 MYCOPHENOLIC ACID J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00078038666 MYFORTIC J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

00078038566 MYFORTIC J7518 MYCOPHENOLIC ACID 11/1/2019 12/31/2299

70748026202 MYCOPHENOLATE MOFETIL J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

70748026201 MYCOPHENOLATE MOFETIL J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

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00054016625 MYCOPHENOLATE MOFETIL J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

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00054016325 MYCOPHENOLATE MOFETIL J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00004026129 CELLCEPT J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00004026043 CELLCEPT J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00004026001 CELLCEPT J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00004025943 CELLCEPT J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00004025901 CELLCEPT J7517 MYCOPHENOLATE MOFETIL ORAL 11/1/2019 12/31/2299

00574086610 CYCLOSPORINE J7516 CYCLOSPORIN PARENTERAL 250MG 11/1/2019 12/31/2299

00517086610 CYCLOSPORINE J7516 CYCLOSPORIN PARENTERAL 250MG 11/1/2019 12/31/2299

00517086601 CYCLOSPORINE J7516 CYCLOSPORIN PARENTERAL 250MG 11/1/2019 12/31/2299

00078010961 SANDIMMUNE J7516 CYCLOSPORIN PARENTERAL 250MG 11/1/2019 12/31/2299

00078010901 SANDIMMUNE J7516 CYCLOSPORIN PARENTERAL 250MG 11/1/2019 12/31/2299

68084087995 CYCLOSPORINE J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

68084087925 CYCLOSPORINE J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

60505463103 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

60505463003 CYCLOSPORINE MODIFIED J7515 CYCLOSPORINE ORAL 25 MG 11/1/2019 12/31/2299

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63323069130 ACETYLCYSTEINE J7608 ACETYLCYSTEINE NON-COMP UNIT 11/1/2019 12/31/2299

63323069044 ACETYLCYSTEINE J7608 ACETYLCYSTEINE NON-COMP UNIT 11/1/2019 12/31/2299

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49502060595 PERFOROMIST J7606 FORMOTEROL FUMARATE, INH 11/1/2019 12/31/2299

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49884012552 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

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00378309832 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00378309785 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00378309732 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00378309685 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00378309632 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00093776824 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00093776819 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00093776724 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

00093776719 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

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00093776619 EVEROLIMUS J7527 ORAL EVEROLIMUS 1/1/2020 12/31/2299

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00054047221 EVEROLIMUS J7527 ORAL EVEROLIMUS 11/1/2019 12/31/2299

00054047121 EVEROLIMUS J7527 ORAL EVEROLIMUS 11/1/2019 12/31/2299

00054047021 EVEROLIMUS J7527 ORAL EVEROLIMUS 11/1/2019 12/31/2299

00469301601 PROGRAF J7525 TACROLIMUS INJECTION 11/1/2019 12/31/2299

69238159406 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

69238159403 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

68462068401 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

68462068301 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

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68084091525 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

66689034702 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

60505619702 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

59762120506 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

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55111065401 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

55111065301 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

50268071813 SIROLIMUS J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

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00008104110 RAPAMUNE J7520 SIROLIMUS, ORAL 11/1/2019 12/31/2299

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66993002335 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

66993002327 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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66993002227 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

66993002135 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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65862094512 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

65862094424 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

65862094412 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

65862094324 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

65862094312 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

47335075349 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

47335074649 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

47335074349 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017424 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017412 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017324 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017312 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017224 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

17478017212 XOPENEX J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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16714009525 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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00115993076 LEVALBUTEROL HCL J7614 LEVALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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76204020060 ALBUTEROL SULFATE J7613 ALBUTEROL NON-COMP UNIT 11/1/2019 12/31/2299

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00115168974 BUDESONIDE J7633 BUDESONIDE NON-COMP CON 11/1/2019 12/31/2299

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00093681619 BUDESONIDE J7633 BUDESONIDE NON-COMP CON 11/1/2019 12/31/2299

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016714046801 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

00378251278 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

00093747489 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

00054027223 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

00004110150 XELODA J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

72606055401 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

72485020460 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

72205000660 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

70756081560 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

69097094903 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

67877045860 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

65162084306 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

64980027606 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

62756023886 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

59923072160 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

59651020460 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

55111049660 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

16729007212 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

16714046701 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

00378251191 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

00093747306 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

00054027121 CAPECITABINE J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

00004110020 XELODA J8520 CAPECITABINE, ORAL, 150 MG 11/1/2019 12/31/2299

59762100501 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

59762010001 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

50742011808 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

49884067314 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

00378280026 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

00093542088 CABERGOLINE J8515 CABERGOLINE, ORAL 0.25MG 11/1/2019 12/31/2299

76388071325 MYLERAN J8510 ORAL BUSULFAN 11/1/2019 12/31/2299

68462058576 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058540 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058476 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058458 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058440 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058385 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462058340 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

68462011233 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059487 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059386 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059286 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059284 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059182 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

13668059181 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781406336 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232368 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232306 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232268 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232246 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232206 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232151 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00781232106 APREPITANT J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00006386203 EMEND J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00006046410 EMEND J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00006046405 EMEND J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00006046401 EMEND J8501 ORAL APREPITANT 11/1/2019 12/31/2299

00006046102 EMEND J8501 ORAL APREPITANT 11/1/2019 12/31/2299

50242006110 AVASTIN J7999 COMPOUNDED DRUG, NOC 11/1/2019 12/31/2299

50242006101 AVASTIN J7999 COMPOUNDED DRUG, NOC 11/1/2019 12/31/2299

50242006010 AVASTIN J7999 COMPOUNDED DRUG, NOC 11/1/2019 12/31/2299

50242006001 AVASTIN J7999 COMPOUNDED DRUG, NOC 11/1/2019 12/31/2299

66302020604 TYVASO INSTITUTIONAL START KIT J7686 TREPROSTINIL, NON-COMP UNIT 11/1/2019 12/31/2299

66302020603 TYVASO J7686 TREPROSTINIL, NON-COMP UNIT 11/1/2019 12/31/2299

66302020602 TYVASO REFILL KIT J7686 TREPROSTINIL, NON-COMP UNIT 11/1/2019 12/31/2299

66302020601 TYVASO STARTER KIT J7686 TREPROSTINIL, NON-COMP UNIT 11/1/2019 12/31/2299

68180096256 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

68180096204 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

66993019594 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

66993019544 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

65162091446 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

47335017149 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

47335017148 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

43598060558 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

43598060556 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

43598060511 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

43598060504 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

17478034038 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

16714011903 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

16714011902 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

10122082056 BETHKIS J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

10122082028 BETHKIS J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

10122082004 BETHKIS J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

00781717184 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

00781717175 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

00781717156 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

00093408563 TOBRAMYCIN J7682 TOBRAMYCIN NON-COMP UNIT 11/1/2019 12/31/2299

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000085143004 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085143003 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085142505 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085142504 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085142503 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085141703 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085141702 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085136605 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085136604 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085136603 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

70720010102 VARUBI J8670 ROLAPITANT, ORAL, 1MG 11/1/2019 12/31/2299

69639010101 AKYNZEO J8655 ORAL NETUPITANT, PALONOSETRO 11/1/2019 12/31/2299

69238142301 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

68382077501 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

67253032036 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

67253032010 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

59651018201 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51285036901 TREXALL J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51285036801 TREXALL J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51285036701 TREXALL J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51285036601 TREXALL J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51079067005 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

51079067001 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

47335023596 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

47335023583 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

16729048601 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00555057235 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00555057202 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00378001401 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00054855025 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00054455025 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

00054455015 METHOTREXATE J8610 METHOTREXATE ORAL 2.5 MG 11/1/2019 12/31/2299

52609000105 ALKERAN J8600 MELPHALAN ORAL 2 MG 11/1/2019 12/31/2299

47781020050 MELPHALAN J8600 MELPHALAN ORAL 2 MG 11/1/2019 12/31/2299

00310048230 IRESSA J8565 GEFITINIB ORAL 11/1/2019 12/31/2299

00378326694 ETOPOSIDE J8560 ETOPOSIDE ORAL 50 MG 11/1/2019 12/31/2299

00378326632 ETOPOSIDE J8560 ETOPOSIDE ORAL 50 MG 11/1/2019 12/31/2299

68047070201 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

64980050924 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

60432046608 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

58463001701 DECADRON J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

58463001601 DECADRON J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

58463001501 DECADRON J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

58463001401 DECADRON J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

54879000308 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004801 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004720 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004711 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004701 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004601 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

48102004501 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

42195015110 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054818325 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054818125 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054818025 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054817925 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054817625 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054817525 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054817425 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418625 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418425 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418325 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418225 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418125 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054418025 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054417925 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054317763 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

00054317757 DEXAMETHASONE J8540 ORAL DEXAMETHASONE 11/1/2019 12/31/2299

72606055501 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

72485020512 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

72205000792 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

70756081622 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

69097094808 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

67877045912 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

65162084416 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

62756023920 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

60687014994 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

60687014911 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

59923072212 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

59651020508 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

55111049704 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

51079051005 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

51079051001 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

50268015413 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

50268015411 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

16729007329 CAPECITABINE J8521 CAPECITABINE, ORAL, 500 MG 11/1/2019 12/31/2299

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059923070505 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070414 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070305 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076312 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076311 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076212 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076211 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076112 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

50268076111 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335093080 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335093074 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335093072 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335093060 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335093021 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335092980 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335092974 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335092972 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335092960 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335092921 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089380 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089374 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089360 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089280 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089274 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089272 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089260 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089221 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089180 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089174 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089172 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089160 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089121 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089080 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089074 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089072 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089060 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

47335089021 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025705 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025614 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025605 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025514 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025505 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025414 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025405 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025314 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025305 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025214 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

43975025205 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729013054 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729013053 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729012954 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729012953 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729005153 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729005054 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729005053 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729004954 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729004953 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729004854 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

16729004853 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269675 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269575 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269544 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269475 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269444 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269375 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269344 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269275 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269244 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269175 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00781269144 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093763957 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093763941 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093763857 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093763841 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093760257 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093760157 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093760141 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093760057 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093760041 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093759957 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00093759941 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085300405 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085300404 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085300403 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085151903 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

00085143005 TEMODAR J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

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054879002710 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

50742043810 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

14789060010 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

14789060007 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

65483011607 PROLEUKIN J9015 ALDESLEUKIN INJECTION 11/1/2019 12/31/2299

70860020851 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

70860020825 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

70860020805 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

67457043650 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323088330 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323088310 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323088305 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323010161 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

62756082640 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

45963073368 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

45963073360 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

45963073357 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

45963073355 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

25021020751 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

25021020725 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

25021020705 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

16714000101 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143954901 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143954801 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143954701 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143954601 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143937201 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143937101 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143937001 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143936901 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143927701 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143927501 ADRIAMYCIN J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403701 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403401 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403301 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403201 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403101 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069403001 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069402625 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069401510 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069400405 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069303420 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069303320 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069303220 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069303120 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00069303020 DOXORUBICIN HCL J9000 DOXORUBICIN HCL INJECTION 11/1/2019 12/31/2299

00078067301 HYCAMTIN J8705 TOPOTECAN ORAL 11/1/2019 12/31/2299

00078067201 HYCAMTIN J8705 TOPOTECAN ORAL 11/1/2019 12/31/2299

68382075596 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075567 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075467 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075296 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075267 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075196 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

68382075167 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080651 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080551 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080514 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080451 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080414 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080351 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080314 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080251 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080214 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080151 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

65162080114 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

64980033405 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092551 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092451 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092414 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092351 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092314 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092251 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092214 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092151 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092114 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092051 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

62559092014 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923071305 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923071214 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923071105 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923071014 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070905 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070814 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070705 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

59923070614 TEMOZOLOMIDE J8700 TEMOZOLOMIDE 11/1/2019 12/31/2299

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000703324811 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703324611 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703324411 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00409112910 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

63323072110 BORTEZOMIB J9044 INJ, BORTEZOMIB, NOS, 0.1 MG 11/1/2019 12/31/2299

43598086560 BORTEZOMIB J9044 INJ, BORTEZOMIB, NOS, 0.1 MG 11/1/2019 12/31/2299

00024582411 JEVTANA J9043 CABAZITAXEL INJECTION 11/1/2019 12/31/2299

00024582315 JEVTANA J9043 CABAZITAXEL INJECTION 11/1/2019 12/31/2299

51144005001 ADCETRIS J9042 BRENTUXIMAB VEDOTIN INJ 11/1/2019 12/31/2299

63323072110 BORTEZOMIB J9041 INJ., VELCADE 0.1 MG 11/1/2019 12/31/2299

63020004904 VELCADE J9041 INJ., VELCADE 0.1 MG 11/1/2019 12/31/2299

63020004901 VELCADE J9041 INJ., VELCADE 0.1 MG 11/1/2019 12/31/2299

43598086560 BORTEZOMIB J9041 INJ., VELCADE 0.1 MG 11/1/2019 12/31/2299

71288010720 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

71288010610 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323013720 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

63323013610 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

61703033218 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

61703032322 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

16714090801 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

16714088601 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00703315501 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00703315401 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409033220 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00409032320 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00143924101 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

00143924001 BLEOMYCIN SULFATE J9040 BLEOMYCIN SULFATE INJECTION 11/1/2019 12/31/2299

55513016001 BLINCYTO J9039 INJECTION, BLINATUMOMAB 11/1/2019 12/31/2299

55513015001 BLINCYTO J9039 INJECTION, BLINATUMOMAB 11/1/2019 12/31/2299

63459034804 BENDEKA J9036 INJ. BELRAPZO/BENDAMUSTINE 11/1/2019 12/31/2299

42367052125 BELRAPZO J9036 INJ. BELRAPZO/BENDAMUSTINE 11/1/2019 12/31/2299

42367052025 BENDAMUSTINE HCL J9036 INJ. BELRAPZO/BENDAMUSTINE 11/1/2019 12/31/2299

50242006110 AVASTIN J9035 BEVACIZUMAB INJECTION 11/1/2019 12/31/2299

50242006101 AVASTIN J9035 BEVACIZUMAB INJECTION 11/1/2019 12/31/2299

50242006010 AVASTIN J9035 BEVACIZUMAB INJECTION 11/1/2019 12/31/2299

50242006001 AVASTIN J9035 BEVACIZUMAB INJECTION 11/1/2019 12/31/2299

63459034804 BENDEKA J9034 INJ., BENDEKA 1 MG 11/1/2019 12/31/2299

42367052125 BELRAPZO J9034 INJ., BENDEKA 1 MG 11/1/2019 12/31/2299

42367052025 BENDAMUSTINE HCL J9034 INJ., BENDEKA 1 MG 11/1/2019 12/31/2299

63459039120 TREANDA J9033 INJ., TREANDA 1 MG 11/1/2019 12/31/2299

63459039008 TREANDA J9033 INJ., TREANDA 1 MG 11/1/2019 12/31/2299

72893000201 BELEODAQ J9032 INJECTION, BELINOSTAT, 10MG 11/1/2019 12/31/2299

00052060202 BCG (TICE STRAIN) J9030 BCG LIVE INTRAVESICAL 1MG 11/1/2019 12/31/2299

00052060201 BCG (TICE STRAIN) J9030 BCG LIVE INTRAVESICAL 1MG 11/1/2019 12/31/2299

72266010801 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

70121123601 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

67457054620 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

63323057270 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

60505616600 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

43598030920 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

00955174601 CLOFARABINE J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

00024586001 CLOLAR J9027 CLOFARABINE INJECTION 11/1/2019 12/31/2299

72606055801 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

72485020101 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

69097080540 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

68001031356 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

67457025430 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

64679009602 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

64679009601 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

63323077139 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

59572010201 VIDAZA J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

51991079798 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

43598046562 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

43598030562 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

16729030610 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

16714092701 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

16714077701 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

00781925394 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

00781325394 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

00143960601 AZACITIDINE J9025 AZACITIDINE INJECTION 11/1/2019 12/31/2299

44087353501 BAVENCIO J9023 INJECTION, AVELUMAB, 10 MG 11/1/2019 12/31/2299

50242091801 TECENTRIQ J9022 INJ, ATEZOLIZUMAB,10 MG 11/1/2019 12/31/2299

50242091701 TECENTRIQ J9022 INJ, ATEZOLIZUMAB,10 MG 11/1/2019 12/31/2299

57902024905 ERWINAZE J9019 ERWINAZE INJECTION 11/1/2019 12/31/2299

57902024901 ERWINAZE J9019 ERWINAZE INJECTION 11/1/2019 12/31/2299

70710161006 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

70710161001 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

69918072010 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

69918072002 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

69918072001 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

68382099710 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

68382099701 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

63459060111 TRISENOX J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

63459060106 TRISENOX J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

63323063710 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

63323063703 ARSENIC TRIOXIDE J9017 ARSENIC TRIOXIDE INJECTION 11/1/2019 12/31/2299

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000781325594 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

00781324494 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

00781323394 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

67457045010 CLADRIBINE J9065 INJ CLADRIBINE PER 1 MG 11/1/2019 12/31/2299

63323014010 CLADRIBINE J9065 INJ CLADRIBINE PER 1 MG 11/1/2019 12/31/2299

42658001001 CLADRIBINE J9065 INJ CLADRIBINE PER 1 MG 11/1/2019 12/31/2299

00143987101 CLADRIBINE J9065 INJ CLADRIBINE PER 1 MG 11/1/2019 12/31/2299

70860020651 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

70860020650 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

68001028333 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

68001028332 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

68001028327 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

68001028324 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

63323010365 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

63323010364 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

63323010351 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

44567051101 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

44567051001 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

44567050901 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

16729028838 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

16729028811 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

00703574811 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

00703574711 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

00143950501 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

00143950401 CISPLATIN J9060 CISPLATIN 10 MG INJECTION 11/1/2019 12/31/2299

50419038501 ALIQOPA J9057 INJ., COPANLISIB, 1 MG 11/1/2019 12/31/2299

66733095823 ERBITUX J9055 CETUXIMAB INJECTION 11/1/2019 12/31/2299

66733094823 ERBITUX J9055 CETUXIMAB INJECTION 11/1/2019 12/31/2299

70710152509 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

70710152401 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

70121166801 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

70121148202 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

54879003664 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

54879002351 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

23155064941 CARMUSTINE J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

23155058931 BICNU J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

23155026141 BICNU J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

23155026131 BICNU J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

00015301260 BICNU J9050 CARMUSTINE INJECTION 11/1/2019 12/31/2299

76075010301 KYPROLIS J9047 INJECTION, CARFILZOMIB, 1 MG 11/1/2019 12/31/2299

76075010201 KYPROLIS J9047 INJECTION, CARFILZOMIB, 1 MG 11/1/2019 12/31/2299

76075010101 KYPROLIS J9047 INJECTION, CARFILZOMIB, 1 MG 11/1/2019 12/31/2299

71288010051 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

71288010045 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

71288010015 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

71288010005 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

69448000538 PARAPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

69448000534 PARAPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

69448000533 PARAPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

69448000531 PARAPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

69448000512 PARAPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

66758004704 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

63323017260 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

63323017245 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

63323017215 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

63323017205 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

61703033962 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

61703033956 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

61703033950 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

61703033922 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

61703033918 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

55150038601 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

55150033501 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

50742044860 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

50742044745 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

50742044615 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

50742044505 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

47335030040 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

47335028440 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

47335015140 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

47335015040 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

25021020251 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

25021020245 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

16729029534 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

16729029533 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

16729029531 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

16729029512 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424891 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424881 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424801 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424681 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424601 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424481 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703424401 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703423981 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

00703423901 CARBOPLATIN J9045 CARBOPLATIN INJECTION 11/1/2019 12/31/2299

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11/24/2020

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055566840200 FIRMAGON J9155 DEGARELIX INJECTION 11/1/2019 12/31/2299

55566830301 FIRMAGON J9155 DEGARELIX INJECTION 11/1/2019 12/31/2299

68727074505 VYXEOS J9153 INJ DAUNORUBICIN, CYTARABINE 11/1/2019 12/31/2299

68727074502 VYXEOS J9153 INJ DAUNORUBICIN, CYTARABINE 11/1/2019 12/31/2299

68727074501 VYXEOS J9153 INJ DAUNORUBICIN, CYTARABINE 11/1/2019 12/31/2299

63323011908 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

42658002102 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

42658002101 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00703523393 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00703523391 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00703523313 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00703523311 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00143955110 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00143955101 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

00143955001 DAUNORUBICIN HCL J9150 DAUNORUBICIN INJECTION 11/1/2019 12/31/2299

57894050220 DARZALEX J9145 INJECTION, DARATUMUMAB 10 MG 11/1/2019 12/31/2299

57894050205 DARZALEX J9145 INJECTION, DARATUMUMAB 10 MG 11/1/2019 12/31/2299

63323012820 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

63323012710 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

61703032722 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

00703507503 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

00703507501 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

00143924510 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

00143924501 DACARBAZINE J9130 DACARBAZINE 100 MG INJ 11/1/2019 12/31/2299

67457092802 DACTINOMYCIN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

67457051305 DACTINOMYCIN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

66993048983 DACTINOMYCIN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

55292081155 COSMEGEN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

39822210002 DACTINOMYCIN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

39822210001 DACTINOMYCIN J9120 DACTINOMYCIN INJECTION 11/1/2019 12/31/2299

61755000801 LIBTAYO J9119 INJ., CEMIPLIMAB-RWLC, 1 MG 11/1/2019 12/31/2299

72694051501 ASPARLAS J9118 INJ. CALASPARGASE PEGOL-MKNL 11/1/2019 12/31/2299

71288010920 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

67457045552 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

67457045500 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

67457045450 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

67457045220 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

63323012020 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

61703031922 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

61703030558 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

61703030538 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

61703030436 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

61703030346 CYTARABINE J9100 CYTARABINE HCL 100 MG INJ 11/1/2019 12/31/2299

72603032601 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

72603010401 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

70121124001 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

70121123901 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

70121123801 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001044432 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001044327 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001044226 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037233 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037232 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037133 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037132 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037027 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

68001037024 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

50742052005 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 7/1/2020 12/31/2299

50742051902 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 7/1/2020 12/31/2299

16714085901 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

16714085801 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

16714085701 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095711 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095701 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095616 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095601 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095550 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019095501 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094510 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094501 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094450 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094401 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094325 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094301 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094210 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019094201 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093950 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093901 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093825 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093801 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093710 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093701 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093650 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093601 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093525 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

10019093501 CYCLOPHOSPHAMIDE J9070 CYCLOPHOSPHAMIDE 100 MG INJ 11/1/2019 12/31/2299

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08/26/2020

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063323019606 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

63323019202 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

61703034418 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

59923060402 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

45963062151 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

45963060955 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

25021024202 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

24201023701 FLUDARABINE PHOSPHATE J9185 FLUDARABINE PHOSPHATE INJ 11/1/2019 12/31/2299

68001026527 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

68001026526 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

68001026525 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

68001026524 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

68001026523 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

68001026522 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

63323010450 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

63323010425 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

63323010405 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

63323010401 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

61269041020 ETOPOPHOS J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

16729026231 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

16729011431 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

16729011411 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

16729011408 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00703565701 TOPOSAR J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00703565601 TOPOSAR J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00703565301 TOPOSAR J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00143951201 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00143951101 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00143951001 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

00143937601 ETOPOSIDE J9181 ETOPOSIDE INJECTION 11/1/2019 12/31/2299

62856038901 HALAVEN J9179 ERIBULIN MESYLATE INJECTION 11/1/2019 12/31/2299

66758004202 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

66758004201 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

61703034859 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

59923070125 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

59923070100 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

45963060868 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

00143920301 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

00143920201 EPIRUBICIN HCL J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

00009509301 ELLENCE J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

00009509101 ELLENCE J9178 INJ, EPIRUBICIN HCL, 2 MG 11/1/2019 12/31/2299

51144003001 PADCEV J9177 INJ ENFORT VEDO-EJFV 0.25MG 7/1/2020 12/31/2299

51144002001 PADCEV J9177 INJ ENFORT VEDO-EJFV 0.25MG 7/1/2020 12/31/2299

00003452211 EMPLICITI J9176 INJECTION, ELOTUZUMAB, 1MG 11/1/2019 12/31/2299

00003229111 EMPLICITI J9176 INJECTION, ELOTUZUMAB, 1MG 11/1/2019 12/31/2299

00310461150 IMFINZI J9173 INJ., DURVALUMAB, 10 MG 11/1/2019 12/31/2299

00310450012 IMFINZI J9173 INJ., DURVALUMAB, 10 MG 11/1/2019 12/31/2299

72485021504 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

72485021401 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

67457053316 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

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66758005003 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

66758005002 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

66758005001 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

50742046316 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

50742043108 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

50742042802 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

47335089540 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

47335032340 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

47335028641 DOCEFREZ J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

47335028541 DOCEFREZ J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

45963076552 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

45963073454 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

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43066001001 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

43066000601 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

43066000101 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

25021024504 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

25021024501 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

16729026764 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

16729026763 DOCETAXEL J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

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00075800404 TAXOTERE J9171 DOCETAXEL INJECTION 11/1/2019 12/31/2299

55566840301 FIRMAGON J9155 DEGARELIX INJECTION 11/1/2019 12/31/2299

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067457046420 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

67457046201 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

63323012600 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

63323012594 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

63323012553 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

63323010294 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

63323010213 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

60505611502 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

60505611400 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

60505611306 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

55111068725 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

55111068607 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

47335015440 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

47335015340 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

45963062458 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

45963061959 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

25021023952 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

25021023926 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

25021023905 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

25021023550 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

25021023410 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155052931 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155052831 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155048431 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155048331 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155021431 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

23155021331 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16729042605 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16729042333 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16729041903 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16729039130 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16714093001 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

16714090901 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00703577501 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018701 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018601 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018501 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018325 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018301 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018225 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018201 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018125 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

00409018101 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

61703033109 FUDR J9200 FLOXURIDINE INJECTION 11/1/2019 12/31/2299

00143927001 FLOXURIDINE J9200 FLOXURIDINE INJECTION 11/1/2019 12/31/2299

62756097460 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756074660 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756061460 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756053360 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756043860 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756032160 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756021960 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756010260 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756007360 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

62756000860 INFUGEM J9198 INJ. INFUGEM, 100 MG 7/1/2020 12/31/2299

68001026633 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026632 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026631 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026630 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026629 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026628 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026627 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

68001026624 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011769 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011768 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011761 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011759 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011758 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011751 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011728 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011720 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011719 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011718 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011710 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

63323011701 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

25021021599 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

25021021598 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027668 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027667 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027638 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027611 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027605 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

16729027603 FLUOROURACIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

00703301911 ADRUCIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

00703301811 ADRUCIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

00703301511 ADRUCIL J9190 FLUOROURACIL INJECTION 11/1/2019 12/31/2299

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025021020166 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

25021020111 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

25021020110 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

10019095362 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

10019095302 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

10019095301 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

00338130501 MESNEX J9209 MESNA INJECTION 11/1/2019 12/31/2299

63323017460 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

63323017420 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

63323014212 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

63323014210 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

10019092616 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

10019092602 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

10019092582 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

10019092501 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00703342911 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00703342711 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00338399301 IFEX J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00338399101 IFEX J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00143953101 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

00143953001 IFOSFAMIDE J9208 IFOSFAMIDE INJECTION 11/1/2019 12/31/2299

70020191102 IXEMPRA J9207 IXABEPILONE INJECTION 11/1/2019 12/31/2299

70020191101 IXEMPRA J9207 IXABEPILONE INJECTION 11/1/2019 12/31/2299

70020191002 IXEMPRA J9207 IXABEPILONE INJECTION 11/1/2019 12/31/2299

70020191001 IXEMPRA J9207 IXABEPILONE INJECTION 11/1/2019 12/31/2299

72485021315 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

72485021205 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

72485021102 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

70700017022 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

70700016922 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

68001028435 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

68001028434 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

63323019355 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

63323019352 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

63323019305 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

63323019302 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

61703034936 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

61703034916 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

61703034909 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

60505612801 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

60505612800 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

59923071615 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

59923071505 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

59923071402 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

55150035401 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

55150035301 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

55150035201 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

50742040205 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

50742040102 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

45963061485 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

45963061481 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

45963061455 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

45963061451 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

25021023005 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

25021023002 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

23155017932 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

23155017931 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

16714013101 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

16714002701 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

10019093417 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

10019093401 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00143970201 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00143970101 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00143958301 IRINOTECAN HCL J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00009752905 CAMPTOSAR J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00009752904 CAMPTOSAR J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

00009752903 CAMPTOSAR J9206 IRINOTECAN INJECTION 11/1/2019 12/31/2299

15054004301 ONIVYDE J9205 INJ IRINOTECAN LIPOSOME 1 MG 11/1/2019 12/31/2299

42747076101 POTELIGEO J9204 INJ MOGAMULIZUMAB-KPKC, 1 MG 11/1/2019 12/31/2299

00008451001 MYLOTARG J9203 GEMTUZUMAB OZOGAMICIN 0.1 MG 11/1/2019 12/31/2299

70720095130 ZOLADEX J9202 GOSERELIN ACETATE IMPLANT 11/1/2019 12/31/2299

70720095036 ZOLADEX J9202 GOSERELIN ACETATE IMPLANT 11/1/2019 12/31/2299

72485022320 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

72485022210 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

72485022102 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

71288011450 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

71288011310 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

70860020550 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

68001035937 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

68001034836 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

68001034234 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

68001028226 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

68001028223 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

67457061810 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

67457061730 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

67457061610 GEMCITABINE HCL J9201 IN GEMCITABINE HCL NOS 200MG 11/1/2019 12/31/2299

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061703035009 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027735 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027730 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027703 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367881 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367801 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367501 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367101 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143983001 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143951910 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143951901 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143936701 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

72893000101 EVOMELA J9246 INJ., EVOMELA, 1 MG 7/1/2020 12/31/2299

72893000101 EVOMELA J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

72266014401 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

72266012801 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

71288011290 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

71288011110 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

70860021461 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

70860021210 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

67457057901 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

67457057750 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

67457021501 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

67457019501 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

67457019350 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

63323076120 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

63323076020 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

52609300200 ALKERAN J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

52609300100 ALKERAN J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

45963068749 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

45963068602 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

43598039248 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

43598039150 MELPHALAN HCL J9245 INJ MELPHA HYDROCH NOS 50 MG 11/1/2019 12/31/2299

00008010001 BESPONSA J9229 INJ INOTUZUMAB OZOGAM 0.1 MG 11/1/2019 12/31/2299

00003232822 YERVOY J9228 IPILIMUMAB INJECTION 11/1/2019 12/31/2299

00003232711 YERVOY J9228 IPILIMUMAB INJECTION 11/1/2019 12/31/2299

00024065601 SARCLISA J9227 INJ. ISATUXIMAB-IRFC 10 MG 10/1/2020 12/31/2299

00024065401 SARCLISA J9227 INJ. ISATUXIMAB-IRFC 10 MG 10/1/2020 12/31/2299

67979000201 SUPPRELIN LA J9226 SUPPRELIN LA IMPLANT 11/1/2019 12/31/2299

67979050001 VANTAS J9225 VANTAS IMPLANT 11/1/2019 12/31/2299

47335093640 LEUPROLIDE ACETATE J9218 LEUPROLIDE ACETATE INJECITON 11/1/2019 12/31/2299

00781400332 LEUPROLIDE ACETATE J9218 LEUPROLIDE ACETATE INJECITON 11/1/2019 12/31/2299

00781300642 LEUPROLIDE ACETATE J9218 LEUPROLIDE ACETATE INJECITON 11/1/2019 12/31/2299

00703401418 LEUPROLIDE ACETATE J9218 LEUPROLIDE ACETATE INJECITON 11/1/2019 12/31/2299

62935075474 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935075375 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935045444 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935045345 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935030529 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935030330 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935022305 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935022104 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

62935022004 ELIGARD J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

00074368303 LUPRON DEPOT J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

00074364203 LUPRON DEPOT J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

00074347303 LUPRON DEPOT J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

00074334603 LUPRON DEPOT J9217 LEUPROLIDE ACETATE SUSPNSION 11/1/2019 12/31/2299

75987011111 ACTIMMUNE J9216 INTERFERON GAMMA 1-B INJ 11/1/2019 12/31/2299

75987011110 ACTIMMUNE J9216 INTERFERON GAMMA 1-B INJ 11/1/2019 12/31/2299

00085435201 INTRON A J9214 INTERFERON ALFA-2B INJ 11/1/2019 12/31/2299

00085435101 INTRON A J9214 INTERFERON ALFA-2B INJ 11/1/2019 12/31/2299

00085435001 INTRON A J9214 INTERFERON ALFA-2B INJ 11/1/2019 12/31/2299

00085116801 INTRON A J9214 INTERFERON ALFA-2B INJ 11/1/2019 12/31/2299

00085113301 INTRON A J9214 INTERFERON ALFA-2B INJ 11/1/2019 12/31/2299

63323019420 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323019410 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

63323019405 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00703415611 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00703415511 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00703415411 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143930801 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143930701 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143930601 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143921901 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143921801 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00143921701 IDARUBICIN HCL J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00013259691 IDAMYCIN PFS J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00013258691 IDAMYCIN PFS J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

00013257691 IDAMYCIN PFS J9211 IDARUBICIN HCL INJECTION 11/1/2019 12/31/2299

72171050501 GAMIFANT J9210 INJ., EMAPALUMAB-LZSG, 1 MG 11/1/2019 12/31/2299

72171050101 GAMIFANT J9210 INJ., EMAPALUMAB-LZSG, 1 MG 11/1/2019 12/31/2299

70860020910 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

63323073311 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

63323073310 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

47781062222 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

25021020167 MESNA J9209 MESNA INJECTION 11/1/2019 12/31/2299

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068001034128 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

67457046910 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

67457044220 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323075020 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323075010 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323065027 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323065020 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323065017 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323021220 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323021110 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323017650 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63323017530 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

61703036322 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

61703036318 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

61703036250 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

61703036135 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

60505613207 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

60505613206 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

55150033201 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

55150033101 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

50742040620 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

50742040510 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

47335017840 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

47335017640 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

47335004740 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

47335004640 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

45963063858 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

45963063749 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

45963061159 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

45963061153 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

43066001801 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

43066001401 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

25021023320 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

25021023310 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

16729033205 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

16729033203 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

16714072701 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00955173320 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00955173110 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00955172720 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00955172510 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00781931780 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00781931570 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00781331780 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00781331570 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00703398601 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

00703398501 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

63459017714 SYNRIBO J9262 INJ, OMACETAXINE MEP, 0.01MG 11/1/2019 12/31/2299

00078068361 ARRANON J9261 NELARABINE INJECTION 11/1/2019 12/31/2299

00078068306 ARRANON J9261 NELARABINE INJECTION 11/1/2019 12/31/2299

67457048040 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

67457046610 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012310 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012302 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012259 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012250 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012110 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012108 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703040841 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035038 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035037 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035010 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035009 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027735 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027730 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

16729027703 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367881 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367801 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367501 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00703367101 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143983001 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143951910 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143951901 METHOTREXATE SODIUM J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

00143936701 METHOTREXATE J9260 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

67457048040 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

67457046610 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012310 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012302 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012259 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012250 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012110 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

63323012108 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703040841 METHOTREXATE SODIUM J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035038 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035037 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

61703035010 METHOTREXATE J9250 METHOTREXATE SODIUM INJ 11/1/2019 12/31/2299

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063323013210 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

61703034366 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

61703034365 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

61703034318 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

00703468601 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

00703468501 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

00703468001 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

69448000338 MUTAMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

69448000211 MUTAMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

69448000105 MUTAMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001039180 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001039179 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001039078 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001039077 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001038936 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

68001038928 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

67457099740 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

67457099620 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

67457052040 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

67457051920 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

67457051805 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729024838 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729024711 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729024605 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729011638 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729011505 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

16729010811 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

00143928001 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

00143927901 MITOMYCIN J9280 MITOMYCIN INJECTION 11/1/2019 12/31/2299

00006302604 KEYTRUDA J9271 INJ PEMBROLIZUMAB 11/1/2019 12/31/2299

00006302602 KEYTRUDA J9271 INJ PEMBROLIZUMAB 11/1/2019 12/31/2299

00006302601 KEYTRUDA J9271 INJ PEMBROLIZUMAB 11/1/2019 12/31/2299

72187040101 ELZONRIS J9269 INJ. TAGRAXOFUSP-ERZS 10 MCG 11/1/2019 12/31/2299

00409080101 NIPENT J9268 PENTOSTATIN INJECTION 11/1/2019 12/31/2299

72205006301 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

72205006201 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

72205006101 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

70860020050 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

70860020017 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

70860020005 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

67457047152 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

67457043451 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076352 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076350 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076317 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076316 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076306 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

63323076305 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

61703034250 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

61703034222 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

47781059507 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061389 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061386 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061383 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061359 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061356 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

45963061353 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

44567050601 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

44567050501 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321881 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321801 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321701 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321681 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321601 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321381 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00703321301 PACLITAXEL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00172375695 ONXOL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

00172375494 ONXOL J9267 PACLITAXEL INJECTION 11/1/2019 12/31/2299

72694095401 ONCASPAR J9266 PEGASPARGASE INJECTION 11/1/2019 12/31/2299

00944381001 ONCASPAR J9266 PEGASPARGASE INJECTION 11/1/2019 12/31/2299

68817013450 ABRAXANE J9264 PACLITAXEL PROTEIN BOUND 11/1/2019 12/31/2299

72603030101 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72603010101 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266016201 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266016101 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266012610 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266012601 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266012510 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

72266012501 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

71288010120 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

71288010110 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

70860020120 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

70860020110 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

68001034137 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

68001034136 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

68001034129 OXALIPLATIN J9263 OXALIPLATIN 11/1/2019 12/31/2299

Page 94: NDC - Procedure Code Crosswalk - Kentucky

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025021020401 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

00703418301 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

00703418201 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

72893000803 MARQIBO J9371 INJ, VINCRISTINE SUL LIP 1MG 11/1/2019 12/31/2299

20536032201 MARQIBO J9371 INJ, VINCRISTINE SUL LIP 1MG 11/1/2019 12/31/2299

61703030926 VINCRISTINE SULFATE J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

61703030925 VINCRISTINE SULFATE J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

61703030916 VINCRISTINE SULFATE J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

61703030906 VINCRISTINE SULFATE J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

00703441211 VINCASAR PFS J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

00703440211 VINCASAR PFS J9370 VINCRISTINE SULFATE 1 MG INJ 11/1/2019 12/31/2299

63323027810 VINBLASTINE SULFATE J9360 VINBLASTINE SULFATE INJ 11/1/2019 12/31/2299

65597040601 ENHERTU J9358 INJ FAM-TRASTU DERU-NXKI 1MG 7/1/2020 12/31/2299

67979000101 VALSTAR J9357 VALRUBICIN INJECTION 11/1/2019 12/31/2299

24201010104 VALRUBICIN J9357 VALRUBICIN INJECTION 11/1/2019 12/31/2299

24201010101 VALRUBICIN J9357 VALRUBICIN INJECTION 11/1/2019 12/31/2299

50242007701 HERCEPTIN HYLECTA J9356 INJ. HERCEPTIN HYLECTA, 10MG 11/1/2019 12/31/2299

50242013210 HERCEPTIN J9355 INJ TRASTUZUMAB EXCL BIOSIMI 11/1/2019 12/31/2299

50242013201 HERCEPTIN J9355 INJ TRASTUZUMAB EXCL BIOSIMI 11/1/2019 12/31/2299

50242008801 KADCYLA J9354 INJ, ADO-TRASTUZUMAB EMT 1MG 11/1/2019 12/31/2299

50242008701 KADCYLA J9354 INJ, ADO-TRASTUZUMAB EMT 1MG 11/1/2019 12/31/2299

59676061001 YONDELIS J9352 INJECTION TRABECTEDIN 0.1MG 11/1/2019 12/31/2299

67457066205 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

63323076294 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

63323076217 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

63323076210 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

62756002340 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

50742040401 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

45963061556 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

16729024331 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

16729015131 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

00703471471 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

00703471401 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

00409030201 TOPOTECAN HCL J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

00078067461 HYCAMTIN J9351 TOPOTECAN INJECTION 11/1/2019 12/31/2299

72205004601 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

72205004501 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

70121163101 TEPADINA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

70121163001 TEPADINA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

54879001413 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

43598065011 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

25021024602 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

00143956501 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

00143930901 THIOTEPA J9340 THIOTEPA INJECTION 11/1/2019 12/31/2299

72611078502 TEMSIROLIMUS J9330 TEMSIROLIMUS INJECTION 11/1/2019 12/31/2299

72611078001 TEMSIROLIMUS J9330 TEMSIROLIMUS INJECTION 11/1/2019 12/31/2299

16729022361 TEMSIROLIMUS J9330 TEMSIROLIMUS INJECTION 11/1/2019 12/31/2299

16729022130 TEMSIROLIMUS J9330 TEMSIROLIMUS INJECTION 11/1/2019 12/31/2299

00008117901 TORISEL J9330 TEMSIROLIMUS INJECTION 11/1/2019 12/31/2299

00085138101 TEMODAR J9328 TEMOZOLOMIDE INJECTION 11/1/2019 12/31/2299

55513007901 IMLYGIC J9325 INJ TALIMOGENE LAHERPAREPVEC 11/1/2019 12/31/2299

55513007801 IMLYGIC J9325 INJ TALIMOGENE LAHERPAREPVEC 11/1/2019 12/31/2299

00703463601 ZANOSAR J9320 STREPTOZOCIN INJECTION 11/1/2019 12/31/2299

59572098401 ISTODAX J9315 ROMIDEPSIN INJECTION 11/1/2019 12/31/2299

59572096210 ISTODAX J9315 ROMIDEPSIN INJECTION 11/1/2019 12/31/2299

00069098301 ROMIDEPSIN J9315 ROMIDEPSIN INJECTION 11/1/2019 12/31/2299

00069096101 ROMIDEPSIN J9315 ROMIDEPSIN INJECTION 11/1/2019 12/31/2299

73380470001 LUMOXITI J9313 INJ., LUMOXITI, 0.01 MG 11/1/2019 12/31/2299

00310470001 LUMOXITI J9313 INJ., LUMOXITI, 0.01 MG 11/1/2019 12/31/2299

50242005306 RITUXAN J9312 INJ., RITUXIMAB, 10 MG 11/1/2019 12/31/2299

50242005121 RITUXAN J9312 INJ., RITUXIMAB, 10 MG 11/1/2019 12/31/2299

50242005110 RITUXAN J9312 INJ., RITUXIMAB, 10 MG 11/1/2019 12/31/2299

50242010901 RITUXAN HYCELA J9311 INJ RITUXIMAB, HYALURONIDASE 11/1/2019 12/31/2299

50242010801 RITUXAN HYCELA J9311 INJ RITUXIMAB, HYALURONIDASE 11/1/2019 12/31/2299

50242010501 POLIVY J9309 INJ, POLATUZUMAB VEDOTIN 1MG 1/1/2020 12/31/2299

50242010301 POLIVY J9309 INJ, POLATUZUMAB VEDOTIN 1MG 7/1/2020 12/31/2299

00002767801 CYRAMZA J9308 INJECTION, RAMUCIRUMAB 11/1/2019 12/31/2299

00002766901 CYRAMZA J9308 INJECTION, RAMUCIRUMAB 11/1/2019 12/31/2299

48818000102 FOLOTYN J9307 PRALATREXATE INJECTION 11/1/2019 12/31/2299

48818000101 FOLOTYN J9307 PRALATREXATE INJECTION 11/1/2019 12/31/2299

50242014501 PERJETA J9306 INJECTION, PERTUZUMAB, 1 MG 11/1/2019 12/31/2299

00002764001 ALIMTA J9305 INJ. PEMETREXED NOS 10MG 11/1/2019 12/31/2299

00002762301 ALIMTA J9305 INJ. PEMETREXED NOS 10MG 11/1/2019 12/31/2299

55513095601 VECTIBIX J9303 PANITUMUMAB INJECTION 11/1/2019 12/31/2299

55513095401 VECTIBIX J9303 PANITUMUMAB INJECTION 11/1/2019 12/31/2299

00078100768 KESIMPTA PEN J9302 OFATUMUMAB INJECTION 7/1/2020 12/31/2299

00078066961 ARZERRA J9302 OFATUMUMAB INJECTION 11/1/2019 12/31/2299

00078066913 ARZERRA J9302 OFATUMUMAB INJECTION 11/1/2019 12/31/2299

50242007001 GAZYVA J9301 OBINUTUZUMAB INJ 11/1/2019 12/31/2299

00008451001 MYLOTARG J9301 OBINUTUZUMAB INJ 11/1/2019 12/31/2299

00003377412 OPDIVO J9299 INJECTION, NIVOLUMAB 11/1/2019 12/31/2299

00003377211 OPDIVO J9299 INJECTION, NIVOLUMAB 11/1/2019 12/31/2299

00003373413 OPDIVO J9299 INJECTION, NIVOLUMAB 11/1/2019 12/31/2299

00002771601 PORTRAZZA J9295 INJECTION, NECITUMUMAB, 1 MG 11/1/2019 12/31/2299

63323013215 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

63323013212 MITOXANTRONE HCL J9293 MITOXANTRONE HYDROCHL / 5 MG 11/1/2019 12/31/2299

Page 95: NDC - Procedure Code Crosswalk - Kentucky

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013533061325 PLASMANATE P9043 PLASMA PROTEIN FRACT,5%,50ML 11/1/2019 12/31/2299

13533061321 PLASMANATE P9043 PLASMA PROTEIN FRACT,5%,50ML 11/1/2019 12/31/2299

13533061320 PLASMANATE P9043 PLASMA PROTEIN FRACT,5%,50ML 11/1/2019 12/31/2299

76125079026 ALBUKED-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

76125079025 ALBUKED-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68982062303 ALBUMIN (HUMAN) P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68982062302 ALBUMIN (HUMAN) P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68982062301 ALBUMIN (HUMAN) P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521406 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521405 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521404 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521403 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521402 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

68516521401 ALBUTEIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

44206031091 ALBURX P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

44206031090 ALBURX P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

44206031050 ALBURX P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

44206031025 ALBURX P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

13533069026 PLASBUMIN-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

13533069025 PLASBUMIN-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

13533069021 PLASBUMIN-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

13533069020 PLASBUMIN-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00944049505 FLEXBUMIN P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00944049101 BUMINATE P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00053767092 ALBUMINAR-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00053767091 ALBUMINAR-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00053767032 ALBUMINAR-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

00053767031 ALBUMINAR-5 P9041 ALBUMIN (HUMAN),5%, 50ML 11/1/2019 12/31/2299

73535020801 MONJUVI J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

73380470001 LUMOXITI J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

72187040101 ELZONRIS J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

71287021902 TECARTUS J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

71287021901 TECARTUS J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

68727071201 ZEPZELCA J9999 CHEMOTHERAPY DRUG 4/1/2020 12/31/2299

62756097460 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756074660 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756053360 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756043860 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756032160 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756021960 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756010260 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756007360 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

62756000860 INFUGEM J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

61755000801 LIBTAYO J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

50419038501 ALIQOPA J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

50242026001 PHESGO J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

50242024501 PHESGO J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

00310470001 LUMOXITI J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

00310461150 IMFINZI J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

00310450012 IMFINZI J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

00173089601 BLENREP J9999 CHEMOTHERAPY DRUG 7/1/2020 12/31/2299

00008010001 BESPONSA J9999 CHEMOTHERAPY DRUG 11/1/2019 12/31/2299

00024584101 ZALTRAP J9400 INJ, ZIV-AFLIBERCEPT, 1MG 11/1/2019 12/31/2299

00024584001 ZALTRAP J9400 INJ, ZIV-AFLIBERCEPT, 1MG 11/1/2019 12/31/2299

72603010502 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

72603010501 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

71288055586 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

71288055585 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

70860021174 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

70860021141 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

70121146302 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

68462031732 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

68001042486 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

68001042485 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

67457031105 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

67457031100 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

63323071505 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

63323071501 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

43598026211 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

43598026202 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

25021046274 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

16714011802 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

16714011801 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00781349212 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00781349201 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00781307912 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00781307901 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00591501911 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00591501902 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00310772010 FULVESTRANT J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

00310072010 FASLODEX J9395 INJECTION, FULVESTRANT 11/1/2019 12/31/2299

64370053202 NAVELBINE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

64370053201 NAVELBINE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

45963060756 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

45963060755 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

25021020405 VINORELBINE TARTRATE J9390 VINORELBINE TARTRATE INJ 11/1/2019 12/31/2299

Page 96: NDC - Procedure Code Crosswalk - Kentucky

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068982064302 ALBUMIN (HUMAN) P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68982064301 ALBUMIN (HUMAN) P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521606 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521605 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521604 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521603 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521602 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521601 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

68516521303 ALBUTEIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

64208251208 ALBUMINEX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

64208251207 ALBUMINEX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

64208251204 ALBUMINEX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

64208251203 ALBUMINEX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

44206025191 ALBURX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

44206025190 ALBURX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

44206025110 ALBURX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

44206025105 ALBURX P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069272 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069271 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069221 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069220 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069217 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

13533069216 PLASBUMIN-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00944049302 FLEXBUMIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00944049301 FLEXBUMIN P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00944049003 BUMINATE P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00053768092 ALBUMINAR-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00053768091 ALBUMINAR-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00053768033 ALBUMINAR-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

00053768032 ALBUMINAR-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125079226 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125079225 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125079211 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125079210 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125078425 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125078410 ALBUKED-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521606 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521605 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521604 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521603 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521602 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

68516521601 ALBUTEIN P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

44206025191 ALBURX P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

44206025190 ALBURX P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

44206025110 ALBURX P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

44206025105 ALBURX P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069272 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069271 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069221 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069220 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069217 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

13533069216 PLASBUMIN-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

00053768092 ALBUMINAR-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

00053768091 ALBUMINAR-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

00053768033 ALBUMINAR-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

00053768032 ALBUMINAR-25 P9046 ALBUMIN (HUMAN), 25%, 20 ML 11/1/2019 12/31/2299

76125079026 ALBUKED-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

76125079025 ALBUKED-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68982062303 ALBUMIN (HUMAN) P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68982062302 ALBUMIN (HUMAN) P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68982062301 ALBUMIN (HUMAN) P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521406 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521405 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521404 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521403 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521402 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

68516521401 ALBUTEIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

64208251006 ALBUMINEX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

64208251005 ALBUMINEX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

64208251002 ALBUMINEX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

64208251001 ALBUMINEX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

44206031091 ALBURX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

44206031090 ALBURX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

44206031050 ALBURX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

44206031025 ALBURX P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

13533069026 PLASBUMIN-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

13533069025 PLASBUMIN-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

13533069021 PLASBUMIN-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

13533069020 PLASBUMIN-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00944049505 FLEXBUMIN P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00944049101 BUMINATE P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00053767092 ALBUMINAR-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00053767091 ALBUMINAR-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00053767032 ALBUMINAR-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

00053767031 ALBUMINAR-5 P9045 ALBUMIN (HUMAN), 5%, 250 ML 11/1/2019 12/31/2299

13533061326 PLASMANATE P9043 PLASMA PROTEIN FRACT,5%,50ML 11/1/2019 12/31/2299

Page 97: NDC - Procedure Code Crosswalk - Kentucky

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059762219803 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762219801 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59651000830 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59651000823 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59651000815 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59651000715 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224022230 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224012250 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224012230 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224012209 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224012203 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224002250 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224002230 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224002218 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

51224002206 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268009913 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268009911 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268009815 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268009811 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268007612 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268007611 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268007413 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50268007411 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078910 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078867 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078855 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078810 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078766 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078751 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

50111078710 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

43386047161 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

43386047060 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

42806015134 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

42806015033 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

42806014932 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

42806014731 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

24658070834 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

24658070632 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

16571069603 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

16571069581 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

16571069516 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

16571069503 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00904670861 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00904670806 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781809031 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781809003 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781808931 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781808926 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781579331 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781578931 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00781577606 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00527239532 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00527237032 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00185720670 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00093714923 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00093202723 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00093202694 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00093202631 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00093202623 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069406189 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069406101 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069314019 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069313019 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069312019 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069311019 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069307086 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069307075 ZITHROMAX TRI-PAK Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069307030 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069306075 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069306030 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069305175 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

00069305107 ZITHROMAX Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59338077510 FERAHEME Q0139 FERUMOXYTOL, ESRD USE 11/1/2019 12/31/2299

59338077501 FERAHEME Q0139 FERUMOXYTOL, ESRD USE 11/1/2019 12/31/2299

59338077510 FERAHEME Q0138 FERUMOXYTOL, NON-ESRD 11/1/2019 12/31/2299

59338077501 FERAHEME Q0138 FERUMOXYTOL, NON-ESRD 11/1/2019 12/31/2299

13533061326 PLASMANATE P9048 PLASMAPROTEIN FRACT,5%,250ML 11/1/2019 12/31/2299

13533061325 PLASMANATE P9048 PLASMAPROTEIN FRACT,5%,250ML 11/1/2019 12/31/2299

13533061321 PLASMANATE P9048 PLASMAPROTEIN FRACT,5%,250ML 11/1/2019 12/31/2299

13533061320 PLASMANATE P9048 PLASMAPROTEIN FRACT,5%,250ML 11/1/2019 12/31/2299

76125079226 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125079225 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125079211 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125079210 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125078425 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

76125078410 ALBUKED-25 P9047 ALBUMIN (HUMAN), 25%, 50ML 11/1/2019 12/31/2299

Page 98: NDC - Procedure Code Crosswalk - Kentucky

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051079051720 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

51079051701 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016612 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016611 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016515 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016511 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016415 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016411 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016315 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

50268016311 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

16714005101 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

16714005001 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

16714004901 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

16714004801 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00904689661 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00904689561 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00904689461 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00904689361 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030489 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030410 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030401 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030400 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030389 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030310 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030301 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030300 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030289 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030210 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030201 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030200 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030189 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030110 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030101 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00832030100 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00781591701 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00781591601 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00781591501 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

00781591401 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

70710146002 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

70710145902 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

70710145802 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

70710145701 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017313 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017274 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017272 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017213 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017173 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017113 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

69452017104 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016206 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016113 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016111 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016106 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016013 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016011 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

68180016006 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064290 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064264 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064230 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064169 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064163 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

65862064130 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096405 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096403 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096401 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096201 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096105 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096104 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

64679096101 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

62332025230 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

62332025209 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

62332025130 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

62332025118 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

60687031495 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

60687031425 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

60687028265 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

60687027121 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

60687027111 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762314001 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762313001 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762312001 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762311001 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762305105 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762305102 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762305101 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

59762219807 AZITHROMYCIN Q0144 AZITHROMYCIN DIHYDRATE, ORAL 11/1/2019 12/31/2299

Page 99: NDC - Procedure Code Crosswalk - Kentucky

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068094076362 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68094076359 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68084022111 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68084022101 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68084022011 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68084022001 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024717 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024716 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024704 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024617 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024616 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68001024604 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862039130 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862039110 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862039010 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018830 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018805 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018803 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018730 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018705 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65862018703 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

65162069179 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

63739033310 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

63304045930 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

63304045830 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756035666 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756035664 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756035660 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756024064 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756024060 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756013101 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

62756013001 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

60687025286 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

60687025246 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

60687025240 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

59762299302 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

59762299301 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

59762299002 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

59762299001 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007830 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007810 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007730 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007710 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007630 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

57237007530 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

55111015430 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

55111015330 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

54838055550 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

51672409103 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

50268062215 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

50268062211 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

50268062115 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

50268062111 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

45963053930 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

45963053830 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

45802020565 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

45802020514 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

16714067102 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00904707393 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00904707341 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00904655261 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00904655161 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00378773497 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00378773493 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00378773293 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00078067615 ZOFRAN Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00078067515 ZOFRAN Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

00054006447 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

70710113301 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

70710113201 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

70710113101 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

70710113001 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

69238106201 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

69238106001 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

69238105801 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

69238105601 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687046311 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687046301 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687045211 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687045201 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687044111 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687044101 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687043011 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

60687043001 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

51079051920 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

51079051901 CHLORPROMAZINE HCL Q0161 CHLORPROMAZINE HCL 5MG ORAL 11/1/2019 12/31/2299

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11/16/2020

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11/16/2020

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049348028208 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49348016210 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49348016204 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49348004537 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49348004534 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122044262 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122044078 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122044062 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122042762 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122036126 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

46122035626 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

42806064910 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

42806064901 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

42806064810 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

42806064801 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800047979 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800047978 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800047967 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800047962 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800046278 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800046267 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800046262 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800044983 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800043167 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800043162 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800037934 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800037926 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

36800015178 SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385047978 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385047962 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385046278 DIPHEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385046262 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385043178 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385043126 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

24385037926 DIPHEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034899 PHARBEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034811 PHARBEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034808 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034803 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034799 PHARBEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

16103034711 PHARBEDRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904698520 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904698516 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904674172 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904674070 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904555159 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904555124 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530780 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530760 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530680 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530661 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530660 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904530624 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904427451 SLEEP TABS Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904205661 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00904203524 BANOPHEN Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00536121429 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00536101001 DIPHENHIST Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121173030 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121173010 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121173000 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121097810 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121097800 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121086530 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121086505 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121086500 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121048905 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00121048900 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113047979 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113047978 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113047962 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113047953 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113046262 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113043162 SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

00113037926 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

71930001852 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

71930001830 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

71930001752 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

71930001730 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462015840 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462015813 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462015811 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462015740 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462015713 ONDANSETRON ODT Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462010630 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

68462010530 ONDANSETRON HCL Q0162 ONDANSETRON ORAL 11/1/2019 12/31/2299

Page 101: NDC - Procedure Code Crosswalk - Kentucky

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06/16/2020

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042858086906 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

42858086806 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

42858086706 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

31722096260 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

31722096160 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

31722096060 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

17478076306 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

17478076206 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

17478076106 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

00904674604 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

00904674561 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

00527145206 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

00527145106 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

00527145006 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

51991073599 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

51991073532 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

51991073520 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

42043039040 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

42043039021 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

42043039020 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

42043039002 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

42043039000 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

16714022132 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

16714022130 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

16714022112 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

16714022110 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

16714022101 GRANISETRON HCL Q0166 GRANISETRON HCL 1 MG ORAL 11/1/2019 12/31/2299

59746011506 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

59746011306 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

50268068515 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

50268068511 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

50268068415 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

50268068411 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

00378511001 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

00378510501 PROCHLORPERAZINE MALEATE Q0164 PROCHLORPERAZINE MALEATE 5MG 11/1/2019 12/31/2299

70677004001 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70677002401 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70677000301 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70677000201 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000049201 CHILDREN'S ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000047402 CHILDREN'S ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000047401 CHILDREN'S ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000046701 SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000024502 CHILDREN'S ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000024401 SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000020702 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000020701 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000014401 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000013603 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000013602 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

70000013601 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015219 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015217 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015201 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015119 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015117 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

69339015105 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094002462 CHILDREN'S DIPHENHYDRAMINE Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094002459 CHILDREN'S DIPHENHYDRAMINE Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094002262 CHILDREN'S DIPHENHYDRAMINE Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094002259 CHILDREN'S DIPHENHYDRAMINE Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094001861 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

68094001859 DIPHENHYDRAMINE HCL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

63868082354 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

63868061132 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

63868008724 COMPLETE ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

63868008701 COMPLETE ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011035601 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011034301 NIGHTTIME SLEEP AID Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011031601 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011031001 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011030901 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011028401 CHILDREN'S ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011005803 ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

62011005701 CHILDREN'S ALLERGY Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

60687026756 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

60687026748 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

60687026742 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

58657052816 M-DRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

58657052804 M-DRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

54859081116 ALLERGY RELIEF Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

54838013580 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

54838013570 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

54838013540 SILADRYL Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49483006110 ALLER-G-TIME Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

49483006101 ALLER-G-TIME Q0163 DIPHENHYDRAMINE HCL 50MG 11/1/2019 12/31/2299

Page 102: NDC - Procedure Code Crosswalk - Kentucky

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068382059101 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68084060711 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68084060701 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68084060211 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68084060201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

64980029301 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

64980029201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

64980029101 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

64980029001 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

52536017001 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

52536016801 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

52536016401 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

52536016201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00904660161 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00904660061 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00904659961 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00781804901 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00781804801 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00781804701 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00781804601 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506321 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506228 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506221 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506128 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506121 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00603506021 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00591410401 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00591410301 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00591410201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00591410101 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00378535301 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00378535201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00378535101 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

00378535001 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

61570007901 TIGAN Q0173 TRIMETHOBENZAMIDE HCL 250MG 11/1/2019 12/31/2299

53489037601 TRIMETHOBENZAMIDE HCL Q0173 TRIMETHOBENZAMIDE HCL 250MG 11/1/2019 12/31/2299

43386066024 TRIMETHOBENZAMIDE HCL Q0173 TRIMETHOBENZAMIDE HCL 250MG 11/1/2019 12/31/2299

43386066003 TRIMETHOBENZAMIDE HCL Q0173 TRIMETHOBENZAMIDE HCL 250MG 11/1/2019 12/31/2299

68382004210 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68382004201 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68382004110 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68382004101 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68382004010 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68382004001 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68084015511 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68084015501 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68084015411 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68084015401 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68001016300 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68001016208 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68001016200 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

68001016100 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

65162074510 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

65162052210 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

65162052111 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

65162052110 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

63739021310 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

60432060816 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

57664010988 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

57664010888 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

57664010818 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

57664010788 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

50383080116 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

10702000401 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

10702000350 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

10702000310 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

10702000301 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

10702000201 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00904646161 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00781183201 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00781183010 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00781183001 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00591531901 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00591530710 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00591530701 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

00121092716 PROMETHAZINE HCL Q0169 PROMETHAZINE HCL 12.5MG ORAL 11/1/2019 12/31/2299

67877057060 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

67877056960 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

67877056860 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

60687038621 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

60687038611 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

60687037511 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

60687037501 DRONABINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

53097057060 MARINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

53097056960 MARINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

53097056860 MARINOL Q0167 DRONABINOL 2.5MG ORAL 11/1/2019 12/31/2299

Page 103: NDC - Procedure Code Crosswalk - Kentucky

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068001034536 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

68001034526 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

47335008350 LIPODOX 50 Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

47335008250 LIPODOX Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

47335005040 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

47335004940 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

43598068325 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

43598068235 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

43598054125 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

43598028335 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

16714085601 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

16714074201 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

00338008601 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

00338008001 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

00338006701 DOXIL Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

00338006301 DOXIL Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

30237890006 PROVENGE Q2043 SIPULEUCEL-T AUTO CD54+ 11/1/2019 12/31/2299

00078095819 KYMRIAH Q2042 TISAGENLECLEUCEL CAR-POS T 11/1/2019 12/31/2299

00078084619 KYMRIAH Q2042 TISAGENLECLEUCEL CAR-POS T 11/1/2019 12/31/2299

71287011902 YESCARTA Q2041 AXICABTAGENE CILOLEUCEL CAR+ 11/1/2019 12/31/2299

71287011901 YESCARTA Q2041 AXICABTAGENE CILOLEUCEL CAR+ 11/1/2019 12/31/2299

44567050701 TENIPOSIDE Q2017 TENIPOSIDE, 50 MG 11/1/2019 12/31/2299

70121139007 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

70121139001 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

70121138105 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

70121138101 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051710 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051701 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051700 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051625 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051622 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

67457051600 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

64679073002 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

64679073001 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

64679072902 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

64679072901 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

63323040310 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

63323040304 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

63323040302 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

63323040301 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00641613710 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00641613701 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00641613625 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00641613601 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00517690225 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00517690201 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00409485750 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00409485749 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00409485710 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00409485702 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00143970425 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00143970310 FOSPHENYTOIN SODIUM Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069600125 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069600121 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069600110 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069600102 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069547402 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069547401 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069547102 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

00069547101 CEREBYX Q2009 FOSPHENYTOIN INJ PE 11/1/2019 12/31/2299

68084084711 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

68084084701 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

59762542001 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

14539067505 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

14539067501 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

14539067405 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

14539067401 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00904706561 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00555032402 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00555032304 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00555032302 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00555030204 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00555030202 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00185067405 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00185067401 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00185061505 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00185061501 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00115180402 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00115180401 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00115180302 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00115180301 HYDROXYZINE PAMOATE Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00069542066 VISTARIL Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

00069541066 VISTARIL Q0177 HYDROXYZINE PAMOATE 25MG 11/1/2019 12/31/2299

68382059401 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68382059301 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

68382059201 PERPHENAZINE Q0175 PERPHENAZINE 4MG ORAL 11/1/2019 12/31/2299

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000006503401 ONTRUZANT Q5112 INJ ONTRUZANT 10 MG 4/1/2020 12/31/2299

00006503302 ONTRUZANT Q5112 INJ ONTRUZANT 10 MG 4/1/2020 12/31/2299

00006503301 ONTRUZANT Q5112 INJ ONTRUZANT 10 MG 4/1/2020 12/31/2299

70114010101 UDENYCA Q5111 INJECTION, UDENYCA 0.5 MG 11/1/2019 12/31/2299

00069029410 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029401 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029310 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029301 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029210 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029201 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029110 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

00069029101 NIVESTYM Q5110 NIVESTYM 11/1/2019 12/31/2299

67457083306 FULPHILA Q5108 INJECTION, FULPHILA 11/1/2019 12/31/2299

55513020701 MVASI Q5107 INJ MVASI 10 MG 11/1/2019 12/31/2299

55513020601 MVASI Q5107 INJ MVASI 10 MG 11/1/2019 12/31/2299

61314032610 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

61314032605 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

61314032601 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

61314031810 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

61314031805 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

61314031801 ZARXIO Q5101 INJECTION, ZARXIO 11/1/2019 12/31/2299

59676034001 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676034000 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676032004 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676032000 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676031204 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676031200 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676031002 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676031001 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676031000 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030401 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030400 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030301 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030300 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030201 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

59676030200 PROCRIT Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513047810 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513047801 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513028310 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513028301 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513026710 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513026701 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513014810 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513014801 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513014410 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513014401 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513012610 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

55513012601 EPOGEN Q4081 EPOETIN ALFA, 100 UNITS ESRD 11/1/2019 12/31/2299

66215030330 VENTAVIS Q4074 ILOPROST NON-COMP UNIT DOSE 11/1/2019 12/31/2299

66215030300 VENTAVIS Q4074 ILOPROST NON-COMP UNIT DOSE 11/1/2019 12/31/2299

66215030230 VENTAVIS Q4074 ILOPROST NON-COMP UNIT DOSE 11/1/2019 12/31/2299

66215030200 VENTAVIS Q4074 ILOPROST NON-COMP UNIT DOSE 11/1/2019 12/31/2299

44087882201 REBIF Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087334409 REBIF REBIDOSE Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087334401 REBIF REBIDOSE Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087332209 REBIF REBIDOSE Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087332201 REBIF REBIDOSE Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087018801 REBIF REBIDOSE Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087004409 REBIF Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

44087004403 REBIF Q3028 INJ BETA INTERFERON SQ 1 MCG 11/1/2019 12/31/2299

59627033304 AVONEX PEN Q3027 INJ BETA INTERFERON IM 1 MCG 11/1/2019 12/31/2299

59627022205 AVONEX Q3027 INJ BETA INTERFERON IM 1 MCG 11/1/2019 12/31/2299

72603020001 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

72603010301 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

70710153101 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

70710153001 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

68001034536 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

68001034526 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

47335008350 LIPODOX 50 Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

47335008250 LIPODOX Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

47335005040 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

47335004940 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

43598068325 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

43598068235 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

43598054125 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

43598028335 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

16714085601 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

16714074201 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

00338008601 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

00338008001 DOXORUBICIN HCL LIPOSOME Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

00338006701 DOXIL Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

00338006301 DOXIL Q2050 DOXORUBICIN INJ 10MG 11/1/2019 12/31/2299

72603020001 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

72603010301 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

70710153101 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

70710153001 DOXORUBICIN HCL LIPOSOME Q2049 IMPORTED LIPODOX INJ 11/1/2019 12/31/2299

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069238159608 AMINOCAPROIC ACID S0017 INJECTION, AMINOCAPROIC ACID 11/1/2019 12/31/2299

66689033008 AMINOCAPROIC ACID S0017 INJECTION, AMINOCAPROIC ACID 11/1/2019 12/31/2299

52817081508 AMINOCAPROIC ACID S0017 INJECTION, AMINOCAPROIC ACID 11/1/2019 12/31/2299

49411005208 AMICAR S0017 INJECTION, AMINOCAPROIC ACID 11/1/2019 12/31/2299

17478044708 AMINOCAPROIC ACID S0017 INJECTION, AMINOCAPROIC ACID 11/1/2019 12/31/2299

12496030005 SUBLOCADE Q9992 BUPRENORPHINE XR OVER 100 MG 11/1/2019 12/31/2299

12496030002 SUBLOCADE Q9992 BUPRENORPHINE XR OVER 100 MG 11/1/2019 12/31/2299

12496030001 SUBLOCADE Q9992 BUPRENORPHINE XR OVER 100 MG 11/1/2019 12/31/2299

12496010005 SUBLOCADE Q9991 BUPRENORPH XR 100 MG OR LESS 11/1/2019 12/31/2299

12496010002 SUBLOCADE Q9991 BUPRENORPH XR 100 MG OR LESS 11/1/2019 12/31/2299

12496010001 SUBLOCADE Q9991 BUPRENORPH XR 100 MG OR LESS 11/1/2019 12/31/2299

11994001116 DEFINITY Q9957 INJ PERFLUTREN LIP MICROS,ML 11/1/2019 12/31/2299

11994001104 DEFINITY Q9957 INJ PERFLUTREN LIP MICROS,ML 11/1/2019 12/31/2299

11994001101 DEFINITY Q9957 INJ PERFLUTREN LIP MICROS,ML 11/1/2019 12/31/2299

59338070355 FERIDEX I.V. Q9953 INJ FE-BASED MR CONTRAST,1ML 11/1/2019 12/31/2299

55513067001 AVSOLA Q5121 INJ. AVSOLA, 10 MG 7/1/2020 12/31/2299

61314086601 ZIEXTENZO Q5120 INJ PEGFILGRASTIM-BMEZ 0.5MG 7/1/2020 12/31/2299

00069024901 RUXIENCE Q5119 INJ RUXIENCE, 10 MG 7/1/2020 12/31/2299

00069023801 RUXIENCE Q5119 INJ RUXIENCE, 10 MG 7/1/2020 12/31/2299

00069034201 ZIRABEV Q5118 INJ., ZIRABEV, 10 MG 1/1/2020 12/31/2299

00069031501 ZIRABEV Q5118 INJ., ZIRABEV, 10 MG 1/1/2020 12/31/2299

55513014101 KANJINTI Q5117 INJ., KANJINTI, 10 MG 1/1/2020 12/31/2299

55513013201 KANJINTI Q5117 INJ., KANJINTI, 10 MG 11/1/2019 12/31/2299

00069030601 TRAZIMERA Q5116 INJ., TRAZIMERA, 10 MG 1/1/2020 12/31/2299

00069030501 TRAZIMERA Q5116 INJ., TRAZIMERA, 10 MG 1/1/2020 12/31/2299

63459010450 TRUXIMA Q5115 INJ TRUXIMA 10 MG 1/1/2020 12/31/2299

63459010310 TRUXIMA Q5115 INJ TRUXIMA 10 MG 1/1/2020 12/31/2299

67457099115 OGIVRI Q5114 INJ OGIVRI 10 MG 1/1/2020 12/31/2299

67457084744 OGIVRI Q5114 INJ OGIVRI 10 MG 1/1/2020 12/31/2299

67457084550 OGIVRI Q5114 INJ OGIVRI 10 MG 1/1/2020 12/31/2299

63459030741 HERZUMA Q5113 INJ HERZUMA 10 MG 3/18/2020 12/31/2299

63459030547 HERZUMA Q5113 INJ HERZUMA 10 MG 3/18/2020 12/31/2299

63459030343 HERZUMA Q5113 INJ HERZUMA 10 MG 3/18/2020 12/31/2299

00006503402 ONTRUZANT Q5112 INJ ONTRUZANT 10 MG 4/1/2020 12/31/2299