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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Ascending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
42043-0390-02 42043-0390 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 12, 2016 In Use
42043-0390-20 42043-0390 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 12, 2016 In Use
42043-0390-21 42043-0390 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 12, 2016 In Use
42043-0390-40 42043-0390 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral April 12, 2016 In Use
42747-0726-01 42747-0726 Granisetron Sancuso 3.1 mg/24h Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Transdermal Sept. 12, 2008 In Use
42747-0726-72 42747-0726 Granisetron Sancuso 3.1 mg/24h Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Transdermal Sept. 12, 2008 In Use
66658-0112-01 66658-0112 Palifermin Kepivance 6.25 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Nov. 14, 2012 April 30, 2023 No Longer Used
66658-0112-03 66658-0112 Palifermin Kepivance 6.25 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Dec. 15, 2009 April 20, 2023 No Longer Used
66658-0112-06 66658-0112 Palifermin Kepivance 6.25 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Dec. 15, 2009 April 20, 2023 No Longer Used
66658-0112-24 66658-0112 Palifermin Kepivance 6.25 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Dec. 15, 2009 April 1, 2016 No Longer Used
70518-2378-00 70518-2378 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 23, 2019 Jan. 17, 2020 No Longer Used
70518-2378-02 70518-2378 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Jan. 3, 2020 Oct. 28, 2020 No Longer Used
70934-0294-84 70934-0294 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 29, 2020 Aug. 31, 2023 No Longer Used
70934-0294-95 70934-0294 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 22, 2019 Aug. 31, 2023 No Longer Used
69543-0371-10 69543-0371 Palonosetron hydrochloride Palonosetron hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 19, 2018 Jan. 31, 2026 In Use
00703-5140-01 00703-5140 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Feb. 1, 1994 Sept. 30, 2023 No Longer Used
00703-5145-01 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous June 12, 1997 Sept. 30, 2023 No Longer Used
00703-5145-91 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 13, 2013 April 30, 2023 No Longer Used
52584-0069-00 52584-0069 ONDANSETRON ONDANSETRON 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous July 3, 2018 Nov. 30, 2023 No Longer Used
60505-6105-01 60505-6105 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Sept. 5, 2019 Nov. 30, 2023 No Longer Used
70383-0073-01 70383-0073 MOTIXAFORTIDE ACETATE Aphexda 62.0 mg/1.7mL Ancillary Therapy Immunostimulant Stem cell mobilizer Subcutaneous Sept. 8, 2023 In Use
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 Oct. 31, 2023 No Longer Used
00006-3061-00 00006-3061 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Feb. 3, 2017 In Use
00006-3061-01 00006-3061 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Feb. 3, 2017 In Use
00006-3061-04 00006-3061 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Feb. 3, 2017 May 25, 2021 In Use

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