Red Book(TM) for Windows®
Release: APRIL, 2006
Product Information
Product
Manuf/Dist
Identifier
Form
Strength
Size
UD
AWP
WAC
BAYGAM
Allscripts
54569-5275-00
SOL
2 ml
30.00
BAYGAM
Bayer Corp.
00026-0635-04
SOL
2 ml
30.60
25.50
BAYGAM
Bayer Corp.
00026-0635-12
SOL
10 ml
128.13
102.50
BAYGAM
Phys Total Care
54868-4193-00
SOL
2 ml
37.47
CARIMUNE NF
ZLB Bioplasma
44206-0415-01
PDS
1 GM
ea
115.00
83.50
CARIMUNE NF
ZLB Bioplasma
44206-0418-12
PDS
12 GM
ea
1212.00
716.00
CARIMUNE NF
ZLB Bioplasma
44206-0416-03
PDS
3 GM
ea
303.00
179.00
CARIMUNE NF
ZLB Bioplasma
44206-0417-06
PDS
6 GM
ea
606.00
358.00
FLEBOGAMMA 5%
Grifols USA, Inc.
61953-0003-01
SOL
50 MG/ML
10 ml
48.38
FLEBOGAMMA 5%
Grifols USA, Inc.
61953-0003-02
SOL
50 MG/ML
50 ml
241.92
FLEBOGAMMA 5%
Grifols USA, Inc.
61953-0003-03
SOL
50 MG/ML
100 ml
483.84
FLEBOGAMMA 5%
Grifols USA, Inc.
61953-0003-04
SOL
50 MG/ML
200 ml
967.68
GAMASTAN S/D
Talecris
13533-0635-04
SOL
2 ml
30.60
25.50
GAMASTAN S/D
Talecris
13533-0635-12
SOL
10 ml
128.13
102.50
GAMMAGARD LIQUID
Baxter Bioscience
00944-2700-02
SOL
100 MG/ML
10 ml
110.52
GAMMAGARD LIQUID
Baxter Bioscience
00944-2700-03
SOL
100 MG/ML
25 ml
276.30
GAMMAGARD LIQUID
Baxter Bioscience
00944-2700-04
SOL
100 MG/ML
50 ml
552.60
GAMMAGARD LIQUID
Baxter Bioscience
00944-2700-05
SOL
100 MG/ML
100 ml
1105.20
GAMMAGARD LIQUID
Baxter Bioscience
00944-2700-06
SOL
100 MG/ML
200 ml
2210.40
GAMMAGARD S/D
Baxter Bioscience
00944-2620-04
PDS
10 GM
ea
1009.30
495.60
GAMMAGARD S/D
Baxter Bioscience
00944-2620-02
PDS
2.5 GM
ea
252.33
123.90
GAMMAGARD S/D
Baxter Bioscience
00944-2620-03
PDS
5 GM
ea
504.65
247.80
GAMMAGARD S/D
Baxter Bioscience
00944-2620-01
PDS
0.5 GM
ea
64.80
40.12
GAMMAR-P I.V.
ZLB
00053-7486-10
PDS
10 GM
ea
1000.00
800.00
GAMMAR-P I.V.
ZLB
00053-7486-05
PDS
5 GM
ea
500.00
400.00
GAMUNEX
Talecris
13533-0645-12
SOL
100 MG/ML
10 ml
97.20
81.00
GAMUNEX
Talecris
13533-0645-15
SOL
100 MG/ML
25 ml
243.00
202.50
GAMUNEX
Talecris
13533-0645-20
SOL
100 MG/ML
50 ml
486.00
405.00
GAMUNEX
Talecris
13533-0645-71
SOL
100 MG/ML
100 ml
972.00
810.00
GAMUNEX
Talecris
13533-0645-24
SOL
100 MG/ML
200 ml
1944.00
1620.00
IVEEGAM EN
Baxter Bioscience
64193-0250-50
PDS
5 GM
ea
412.80
OCTAGAM
Octapharma USA
67467-0843-01
SOL
50 MG/ML
20 ml
108.00
57.00
OCTAGAM
Octapharma USA
67467-0843-02
SOL
50 MG/ML
50 ml
270.00
142.50
OCTAGAM
Octapharma USA
67467-0843-03
SOL
50 MG/ML
100 ml
540.00
285.00
OCTAGAM
Octapharma USA
67467-0843-04
SOL
50 MG/ML
200 ml
1080.00
570.00
PANGLOBULIN NF
Amer Red Cross-Blood
52769-0418-12
PDS
12 GM
ea
1212.00
PANGLOBULIN NF
Amer Red Cross-Blood
52769-0417-06
PDS
6 GM
ea
606.00
POLYGAM S/D
Baxter Bioscience
00944-0471-80
PDS
10 GM
ea
1009.30
POLYGAM S/D
Baxter Bioscience
00944-0471-72
PDS
2.5 GM
ea
252.33
POLYGAM S/D
Baxter Bioscience
00944-0471-75
PDS
5 GM
ea
504.65
POLYGAM S/D
Baxter Bioscience
00944-0471-69
PDS
0.5 GM
ea
64.80
Copyright © 2006, Thomson PDR.
Page 1
Red Book(TM) for Windows®
Release: APRIL, 2006
VENOGLOBULIN-S 10%
Grifols USA, Inc.
68516-1622-01
SOL
100 MG/ML
50 ml
575.00
VENOGLOBULIN-S 10%
Grifols USA, Inc.
68516-1623-01
SOL
100 MG/ML
100 ml
1150.00
VENOGLOBULIN-S 10%
Grifols USA, Inc.
68516-1624-01
SOL
100 MG/ML
200 ml
2300.00
VENOGLOBULIN-S 5%
Grifols USA, Inc.
68516-1612-01
SOL
50 MG/ML
50 ml
287.50
VENOGLOBULIN-S 5%
Grifols USA, Inc.
68516-1613-01
SOL
50 MG/ML
100 ml
575.00
VENOGLOBULIN-S 5%
Grifols USA, Inc.
68516-1614-01
SOL
50 MG/ML
200 ml
1150.00
VIVAGLOBIN
ZLB
00053-7596-03
SOL
160 MG/ML
3 ml 10s
576.00
576.00
VIVAGLOBIN
ZLB
00053-7596-10
SOL
160 MG/ML
10 ml
192.00
192.00
VIVAGLOBIN
ZLB
00053-7596-15
SOL
160 MG/ML
10 ml 10s
1920.00
1920.00
VIVAGLOBIN
ZLB
00053-7596-20
SOL
160 MG/ML
20 ml
384.00
384.00
VIVAGLOBIN
ZLB
00053-7596-25
SOL
160 MG/ML
20 ml 10s
3840.00
3840.00
Copyright © 2006, Thomson PDR.
Page 2
Red Book(TM) for Windows®
Release: APRIL, 2006
Detailed Product Information
PRODUCT:
BAYGAM
MANUFACTURER:
Allscripts
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
54569-5275-00
SIZE:
2 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
Y
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
30.00
15.0000
8/29/2002
DIR
HCFA
PRODUCT:
BAYGAM
MANUFACTURER:
Bayer Corp.
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00026-0635-04
SIZE:
2 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
30.60
15.3000
2/17/2003
DIR
HCFA
PRODUCT:
BAYGAM
MANUFACTURER:
Bayer Corp.
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
Copyright © 2006, Thomson PDR.
Page 1
Red Book(TM) for Windows®
Release: APRIL, 2006
GENERIC NAME:IMMUNE GLOBULIN
NDC:
00026-0635-12
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
128.13
12.8130
2/17/2003
DIR
HCFA
PRODUCT:
BAYGAM
MANUFACTURER:
Phys Total Care
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
54868-4193-00
SIZE:
2 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
Y
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
37.47
18.7350
9/30/2004
DIR
HCFA
PRODUCT:
CARIMUNE NF
MANUFACTURER:
ZLB Bioplasma
FORM:
POWDER FOR SOLUTION
STRENGTH:
1 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
44206-0415-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Copyright © 2006, Thomson PDR.
Page 2
Red Book(TM) for Windows®
Release: APRIL, 2006
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
115.00
115.0000
3/20/2003
DIR
HCFA
PRODUCT:
CARIMUNE NF
MANUFACTURER:
ZLB Bioplasma
FORM:
POWDER FOR SOLUTION
STRENGTH:
12 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
44206-0418-12
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1212.00
1212.0000
3/20/2003
DIR
HCFA
PRODUCT:
CARIMUNE NF
MANUFACTURER:
ZLB Bioplasma
FORM:
POWDER FOR SOLUTION
STRENGTH:
3 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
44206-0416-03
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
303.00
303.0000
3/20/2003
DIR
HCFA
Copyright © 2006, Thomson PDR.
Page 3
Red Book(TM) for Windows®
Release: APRIL, 2006
PRODUCT: CARIMUNE NF
MANUFACTURER:
ZLB Bioplasma
FORM:
POWDER FOR SOLUTION
STRENGTH:
6 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
44206-0417-06
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
606.00
606.0000
3/20/2003
DIR
HCFA
PRODUCT:
FLEBOGAMMA 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(0.5 GM/VIAL,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
61953-0003-01
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
48.38
4.8380
12/15/2003
DIR
40.32
4.0320
12/15/2003
HCFA
PRODUCT:
FLEBOGAMMA 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(2.5 GM/VIAL,PF)
GENERIC NAME:
IMMUNE GLOBULIN
Copyright © 2006, Thomson PDR.
Page 4
Red Book(TM) for Windows®
Release: APRIL, 2006
NDC:
61953-0003-02
SIZE:
50 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
241.92
4.8384
12/15/2003
DIR
201.60
4.0320
12/15/2003
HCFA
PRODUCT:
FLEBOGAMMA 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(5 GM/VIAL,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
61953-0003-03
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
483.84
4.8384
12/15/2003
DIR
403.20
4.0320
12/15/2003
HCFA
PRODUCT:
FLEBOGAMMA 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(10 GM/VIAL,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
61953-0003-04
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
Copyright © 2006, Thomson PDR.
Page 5
Red Book(TM) for Windows®
Release: APRIL, 2006
PKG
UNIT
EFF. DATE
AWP
967.68
4.8384
12/15/2003
DIR
806.40
4.0320
12/15/2003
HCFA
PRODUCT:
GAMASTAN S/D
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0635-04
SIZE:
2 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
30.60
15.3000
10/4/2005
DIR
HCFA
PRODUCT:
GAMASTAN S/D
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0635-12
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
128.13
12.8130
10/4/2005
DIR
HCFA
PRODUCT:
GAMMAGARD LIQUID
MANUFACTURER:
Baxter Bioscience
Copyright © 2006, Thomson PDR.
Page 6
Red Book(TM) for Windows®
Release: APRIL, 2006
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2700-02
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
110.52
11.0520
7/1/2005
DIR
HCFA
PRODUCT:
GAMMAGARD LIQUID
MANUFACTURER:
Baxter Bioscience
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2700-03
SIZE:
25 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
276.30
11.0520
7/1/2005
DIR
HCFA
PRODUCT:
GAMMAGARD LIQUID
MANUFACTURER:
Baxter Bioscience
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2700-04
SIZE:
50 ml
Copyright © 2006, Thomson PDR.
Page 7
Red Book(TM) for Windows®
Release: APRIL, 2006
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
552.60
11.0520
7/1/2005
DIR
HCFA
PRODUCT:
GAMMAGARD LIQUID
MANUFACTURER:
Baxter Bioscience
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2700-05
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1105.20
11.0520
7/1/2005
DIR
HCFA
PRODUCT:
GAMMAGARD LIQUID
MANUFACTURER:
Baxter Bioscience
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2700-06
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
Copyright © 2006, Thomson PDR.
Page 8
Red Book(TM) for Windows®
Release: APRIL, 2006
AWP
2210.40
11.0520
7/1/2005
DIR
HCFA
PRODUCT:
GAMMAGARD S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
10 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2620-04
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1009.30
1009.3000
7/26/2002
DIR
HCFA
PRODUCT:
GAMMAGARD S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
2.5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2620-02
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
252.33
252.3300
7/26/2002
DIR
HCFA
PRODUCT:
GAMMAGARD S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
Copyright © 2006, Thomson PDR.
Page 9
Red Book(TM) for Windows®
Release: APRIL, 2006
STRENGTH:
5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2620-03
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
504.65
504.6500
7/26/2002
DIR
HCFA
PRODUCT:
GAMMAGARD S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
0.5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-2620-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
64.80
64.8000
7/2/1998
DIR
HCFA
PRODUCT:
GAMMAR-P I.V.
MANUFACTURER:
ZLB
FORM:
POWDER FOR SOLUTION
STRENGTH:
10 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(W/DILUENT)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7486-10
SIZE:
ea
DEA Class:
RX
Copyright © 2006, Thomson PDR.
Page 10
Red Book(TM) for Windows®
Release: APRIL, 2006
UNIT DOSE (Y/N):N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1000.00
1000.0000
11/1/2002
DIR
HCFA
PRODUCT:
GAMMAR-P I.V.
MANUFACTURER:
ZLB
FORM:
POWDER FOR SOLUTION
STRENGTH:
5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(W/DILUENT)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7486-05
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
500.00
500.0000
11/1/2002
DIR
HCFA
PRODUCT:
GAMUNEX
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0645-12
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
97.20
9.7200
7/15/2005
Copyright © 2006, Thomson PDR.
Page 11
Red Book(TM) for Windows®
Release: APRIL, 2006
DIR
HCFA
PRODUCT:
GAMUNEX
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0645-15
SIZE:
25 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
243.00
9.7200
7/15/2005
DIR
HCFA
PRODUCT:
GAMUNEX
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0645-20
SIZE:
50 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
486.00
9.7200
7/15/2005
DIR
HCFA
PRODUCT:
GAMUNEX
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
100 MG/ML
Copyright © 2006, Thomson PDR.
Page 12
Red Book(TM) for Windows®
Release: APRIL, 2006
ROUTE OF ADMIN:INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0645-71
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
972.00
9.7200
7/15/2005
DIR
HCFA
PRODUCT:
GAMUNEX
MANUFACTURER:
Talecris
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
13533-0645-24
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1944.00
9.7200
7/15/2005
DIR
HCFA
PRODUCT:
IVEEGAM EN
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(IGIV,W/DILUENT,PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
64193-0250-50
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
Copyright © 2006, Thomson PDR.
Page 13
Red Book(TM) for Windows®
Release: APRIL, 2006
N
SINGLE SOURCE (Y/N):
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
412.80
412.8000
7/26/2002
DIR
HCFA
PRODUCT:
OCTAGAM
MANUFACTURER:
Octapharma USA
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(1GM/VIAL,S/D TREATED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
67467-0843-01
SIZE:
20 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
108.00
5.4000
5/26/2004
DIR
HCFA
PRODUCT:
OCTAGAM
MANUFACTURER:
Octapharma USA
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(2.5GM/VIAL,S/D TREATED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
67467-0843-02
SIZE:
50 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
270.00
5.4000
5/26/2004
DIR
Copyright © 2006, Thomson PDR.
Page 14
Red Book(TM) for Windows®
Release: APRIL, 2006
HCFA
PRODUCT:
OCTAGAM
MANUFACTURER:
Octapharma USA
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(5GM/VIAL,S/D TREATED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
67467-0843-03
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
540.00
5.4000
5/26/2004
DIR
HCFA
PRODUCT:
OCTAGAM
MANUFACTURER:
Octapharma USA
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(10GM/VIAL,S/D TREATED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
67467-0843-04
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1080.00
5.4000
5/26/2004
DIR
HCFA
PRODUCT:
PANGLOBULIN NF
MANUFACTURER:
Amer Red Cross-Blood
FORM:
POWDER FOR SOLUTION
STRENGTH:
12 GM
ROUTE OF ADMIN:
INTRAVENOUS
Copyright © 2006, Thomson PDR.
Page 15
Red Book(TM) for Windows®
Release: APRIL, 2006
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
52769-0418-12
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1212.00
1212.0000
9/1/2003
DIR
HCFA
PRODUCT:
PANGLOBULIN NF
MANUFACTURER:
Amer Red Cross-Blood
FORM:
POWDER FOR SOLUTION
STRENGTH:
6 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.,PF,NANOFILTERED)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
52769-0417-06
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
606.00
606.0000
9/1/2003
DIR
HCFA
PRODUCT:
POLYGAM S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
10 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V.W/DILUENT,ADMIN SE
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-0471-80
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
Copyright © 2006, Thomson PDR.
Page 16
Red Book(TM) for Windows®
Release: APRIL, 2006
REPACKAGER (Y/N):N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1009.30
1009.3000
7/1/2005
DIR
HCFA
PRODUCT:
POLYGAM S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
2.5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V. W/DILUENT,ADMIN S
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-0471-72
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
252.33
252.3300
7/1/2005
DIR
HCFA
PRODUCT:
POLYGAM S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V. W/DILUENT,ADMIN S
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-0471-75
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
504.65
504.6500
7/1/2005
DIR
HCFA
Copyright © 2006, Thomson PDR.
Page 17
Red Book(TM) for Windows®
Release: APRIL, 2006
PRODUCT:
POLYGAM S/D
MANUFACTURER:
Baxter Bioscience
FORM:
POWDER FOR SOLUTION
STRENGTH:
0.5 GM
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(S.D.V. W/DILUENT,ADMIN S
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00944-0471-69
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
64.80
64.8000
7/1/2005
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 10%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(5 GM/VIAL,W/ADMIN SET)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
68516-1622-01
SIZE:
50 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
575.00
11.5000
7/25/2003
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 10%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(10 GM/VIAL,W/ADMIN SET)
Copyright © 2006, Thomson PDR.
Page 18
Red Book(TM) for Windows®
Release: APRIL, 2006
GENERIC NAME:IMMUNE GLOBULIN
NDC:
68516-1623-01
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1150.00
11.5000
7/25/2003
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 10%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
100 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(20 GM/VIAL,W/ADMIN SET)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
68516-1624-01
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
2300.00
11.5000
7/25/2003
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(2.5GM VIAL,W/ADMIN SET)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
68516-1612-01
SIZE:
50 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Copyright © 2006, Thomson PDR.
Page 19
Red Book(TM) for Windows®
Release: APRIL, 2006
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
287.50
5.7500
7/25/2003
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(5 GM/VIAL,W/ADMIN SET)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
68516-1613-01
SIZE:
100 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
575.00
5.7500
7/25/2003
DIR
HCFA
PRODUCT:
VENOGLOBULIN-S 5%
MANUFACTURER:
Grifols USA, Inc.
FORM:
SOLUTION
STRENGTH:
50 MG/ML
ROUTE OF ADMIN:
INTRAVENOUS
ORANGE BOOK CODE:
ADD'L DESC:
(10 GM/VIAL,W/ADMIN SET)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
68516-1614-01
SIZE:
200 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
N
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1150.00
5.7500
7/25/2003
DIR
HCFA
Copyright © 2006, Thomson PDR.
Page 20
Red Book(TM) for Windows®
Release: APRIL, 2006
PRODUCT: VIVAGLOBIN
MANUFACTURER:
ZLB
FORM:
SOLUTION
STRENGTH:
160 MG/ML
ROUTE OF ADMIN:
SUBCUTANEOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7596-03
SIZE:
3 ml 10s
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
576.00
19.2000
3/1/2006
DIR
326.98
10.8993
3/1/2006
HCFA
PRODUCT:
VIVAGLOBIN
MANUFACTURER:
ZLB
FORM:
SOLUTION
STRENGTH:
160 MG/ML
ROUTE OF ADMIN:
SUBCUTANEOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7596-10
SIZE:
10 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
192.00
19.2000
3/1/2006
DIR
108.99
10.8990
3/1/2006
HCFA
PRODUCT:
VIVAGLOBIN
MANUFACTURER:
ZLB
FORM:
SOLUTION
STRENGTH:
160 MG/ML
ROUTE OF ADMIN:
SUBCUTANEOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
Copyright © 2006, Thomson PDR.
Page 21
Red Book(TM) for Windows®
Release: APRIL, 2006
NDC:
00053-7596-15
SIZE:
10 ml 10s
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1920.00
19.2000
3/1/2006
DIR
1089.92
10.8992
3/1/2006
HCFA
PRODUCT:
VIVAGLOBIN
MANUFACTURER:
ZLB
FORM:
SOLUTION
STRENGTH:
160 MG/ML
ROUTE OF ADMIN:
SUBCUTANEOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7596-20
SIZE:
20 ml
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
384.00
19.2000
3/1/2006
DIR
217.98
10.8990
3/1/2006
HCFA
PRODUCT:
VIVAGLOBIN
MANUFACTURER:
ZLB
FORM:
SOLUTION
STRENGTH:
160 MG/ML
ROUTE OF ADMIN:
SUBCUTANEOUS
ORANGE BOOK CODE:
ADD'L DESC:
(PF)
GENERIC NAME:
IMMUNE GLOBULIN
NDC:
00053-7596-25
SIZE:
20 ml 10s
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
Y
Current Pricing Information
Copyright © 2006, Thomson PDR.
Page 22
Red Book(TM) for Windows®
Release: APRIL, 2006
PKG
UNIT
EFF. DATE
AWP
3840.00
19.2000
3/1/2006
DIR
2179.84
10.8992
3/1/2006
HCFA
Copyright © 2006, Thomson PDR.
Page 23
