Page 82 - 2017 V1 InsideOut

P Pharmaceuticals
Vaccines
CODE
PRODUCT
SIZE
MFR.
NDC #
PK/CS
Flu - Trivalent Vaccines
CPT 90658
A uria® MDV
5 mL
SEQ
vial
CPT 90656
A uria® PFS
10 x 0.5 mL
SEQ
syringe
CPT 90653
FluadTM
10 x 0.5 mL
SEQ
syringe
CPT 90658
Fluvirin® MDV
5 mL
SEQ
vial
CPT 90656
Fluvirin® PFS
10 x 0.5 mL
SEQ
syringe
CPT 90662
Fluzone® High-Dose
10 x 0.5 mL
SAN
49281-0401-65
syringe
Flu - Quadrivalent Vaccines
CPT 90686
Fluarix® Quadrivalent PFS
10 x 0.5 mL
GSK
pk
CPT 90674
Flucelvax® Quadrivalent PFS
10 x 0.5 mL
SEQ
syringe
CPT 90688
FluLaval® Quadrivalent MDV
5 mL
GSK
vial
CPT 90688
Fluzone® Quadrivalent MDV
5 mL
SAN
49281-0627-15
vial
CPT 90686
Fluzone® Quadrivalent SDV
10 x 0.5 mL
SAN
49281-0417-10
vial
CPT 90686
Fluzone® Quadrivalent PFS
10 x 0.5 mL
SAN
49281-0417-50
syringe
CPT 90685
Fluzone® Quadrivalent Pediatric
10 x 0.25 mL
SAN
49281-0517-25
syringe
CPT 90654
Fluzone® Quadrivalent Intradermal
10 x 0.1 mL
SAN
49281-0712-40
syringe
Haemophilus B Conjugate
90647
Acthib®
5 SDV per pack
SAN
49281-0545-03
pk
Hepatitis A
90632
Havrix Pediatric
10 x 0.5 mL PF SDV
GSK
58160-0825-11
pk
90632
Havrix Adult
TIPLOKS 10/pk
GSK
58160-0826-52
pk
JE- Japanese Encephalitis
Ixiaro JE
0.5 mL PFS
GSK
42515-0001-01
ea
Meningococcal Meningitis
Menactra
5 doses/pk
SAN
49281-0589-05
pk
MMR
90707
MMR II
SDV 10/box
MERCK
00006-4681-00
bx
Pneumococcal Conjugate for Bacterium Streptococcus Pneumoniae
90670
Prevnar 13®
10 x 0.5 mL PFS
PFZ
00005-1971-02
pk
90670
Prevnar 13®
0.5 mL PFS
PFZ
00005-1971-05
ea
TDAP
90715
Adacel® TDAP
10x0.5mL vial
SAN
49281-0400-10
pk
90715
Adacel® TDAP
PFS 5/ctn
SAN
49281-0400-15
pk
90715
Boostrix TDAP
10 x 0.5 mL SDV
GSK
58160-0842-11
pk
Tetanus and Diptheria
90714
Tenivac® TD
PFS 10/ctn 0.5 mL
SAN
49281-0215-15
pk
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