Page 83 - 2017 V1 InsideOut
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CODE PRODUCT
Specialty
CODE PRODUCT
SIZE MFR.
NDC #
PK/CS
Tuberculosis
J3490
Aplisol®
5 TU 1 mL
PAR
42023-0104-01
vial
J3490
Aplisol®
5 TU 5 mL
PAR
42023-0104-05
vial
CPT-86580
Tubersol®
5 TU 1 mL
SAN
49281-0752-21
pk
CPT-86580
Tubersol®
5 TU 5 mL
SAN
49281-0752-22
pk
Hepatitis A and Hepatitis B
Twinrix®
P/F SDV 10 x 1 mL
GSK
58160-0815-11
pk
SIZE MFR.
NDC #
PK/CS
J3262 Actemra® Intravenous 400 mg/20 mL SDV GNT 50242-0137-01 vial
J3490 Actemra® Subcutaneous 162 mg PFS 0.9 mL GNT 50242-0138-01 vial
J2997 Activase® Cath o 2 mg GNT 50242-0041-64 vial
J3490 Ammonul® 50 mL VAL 00187-0010-50 vial
Ampyra® 10 mg/60 tabs ACO 10144-0427-60 btl
Avonex® 30 mcg PFS BIOG 59627-0222-05 pk
Avonex Pen® 30 mcg/0.5 mL inj 4/pk BIOG 59627-0333-04 pk
J0490 Benlysta® 120 mg SDV GSK 49401-0101-01 ea
NEW NEW
J3262 Actemra® Intravenous 80 mg/4 mL SDV GNT 50242-0135-01 vial
J3262 Actemra® Intravenous 200 mg/10 mL SDV GNT 50242-0136-01 vial
J0490 Benlysta® 400 mg SDV GSK 49401-0102-01 ea
J0597 Berinert® 500 unit vial CSL 63833-0825-02 kit
J7682 Bethkis® 300 mg/4 mL CHIE 10122-0820-56 bx
J8499 Buphenyl® 500 mg tabs HRZN 75987-0060-08 btl
J3490 Buphenyl® 250 g powder HRZN 75987-0070-09 btl
J9120 Calcium Disodium Versenate 1000 mg/5 mL VAL 99207-0240-05 pk
Cinqair® 100 mg/10 mL SDV TEVA 59310-0610-31 ea
J0840 CroFab® 2 x 2 mL BTG 50633-0110-12 vial
J0878 Cubicin® 500 mg MERCK 67919-0011-01 10/pk
J0878 Cubicin® RF 500 mg MERCK 67919-0012-01 10/pk
Daptomycin 500 mg/10 mL TEVA 00703-0125-01 vial
Daraprim® 25 mg/30 tabs TUR 69413-0330-30 ea
Daraprim® 25 mg/100 tabs TUR 69413-0330-10 ea
J0894 Decitabine 50 mg PWD SDV DRE 55111-0556-10 vial
J1162 DigiFab® 40 mg BTG 50633-0120-11 vial
J3590 Entyvio® 300 mg/20 mL SDV TAK 64764-0300-20 ea
Envarsus® XR 0.75 mg tab 30/btl VLX 68992-3075-03 btl
Envarsus® XR 0.75 mg tab 100/btl VLX 68992-3075-01 btl
Envarsus® XR 1 mg/30 tabs VLX 68992-3010-03 btl
Envarsus® XR 1 mg/100 tabs VLX 68992-3010-01 btl
Envarsus® XR 4 mg/30 tabs VLX 68992-3040-03 btl
Envarsus® XR 4 mg/100 tabs VLX 68992-3040-01 btl
ASD Healthcare | 79
