Red Book(TM) for Windows®
Release: APRIL, 2006
Product Information
Product
Manuf/Dist
Identifier
Form
Strength
Size
UD
AWP
WAC
LUPRON DEPOT
Phys Total Care
54868-2825-00
PI1
3.75 MG
ea
600.01
LUPRON DEPOT
TAP
00300-3641-01
PI1
3.75 MG
ea
589.52
491.27
LUPRON DEPOT
TAP
00300-3642-01
PI1
7.5 MG
ea
709.20
591.00
LUPRON DEPOT
TAP
00300-3663-01
PI3
11.25 MG
ea
1768.58
1473.82
LUPRON DEPOT
TAP
00300-3346-01
PI3
22.5 MG
ea
2127.59
1772.99
LUPRON DEPOT
TAP
00300-3683-01
PI4
30 MG
ea
2836.79
2363.99
Copyright © 2006, Thomson PDR.
Page 1
Red Book(TM) for Windows®
Release: APRIL, 2006
Detailed Product Information
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
Phys Total Care
FORM:
POWDER FOR SUSPENSION, 1 MONTH
STRENGTH:
3.75 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
GENERIC NAME:
LEUPROLIDE ACETATE
NDC:
54868-2825-00
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
Y
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
600.01
600.0100
9/30/2004
DIR
HCFA
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
TAP
FORM:
POWDER FOR SUSPENSION, 1 MONTH
STRENGTH:
3.75 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(SRN,PREFIL DUAL CHAMBER)
GENERIC NAME:
LEUPROLIDE ACETATE
NDC:
00300-3641-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
589.52
589.5200
7/2/2005
DIR
HCFA
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
TAP
FORM:
POWDER FOR SUSPENSION, 1 MONTH
STRENGTH:
7.5 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(SRN,PREFIL DUAL CHAMBER)
Copyright © 2006, Thomson PDR.
Page 1
Red Book(TM) for Windows®
Release: APRIL, 2006
GENERIC NAME:LEUPROLIDE ACETATE
NDC:
00300-3642-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
709.20
709.2000
7/2/2005
DIR
HCFA
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
TAP
FORM:
POWDER FOR SUSPENSION, 3 MONTH
STRENGTH:
11.25 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(SRN,PREFIL DUAL CHAMBER)
GENERIC NAME:
LEUPROLIDE ACETATE
NDC:
00300-3663-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
1768.58
1768.5800
7/2/2005
DIR
HCFA
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
TAP
FORM:
POWDER FOR SUSPENSION, 3 MONTH
STRENGTH:
22.5 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(SRN,PREFIL DUAL CHAMBER)
GENERIC NAME:
LEUPROLIDE ACETATE
NDC:
00300-3346-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
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
2127.59
2127.5900
7/2/2005
DIR
HCFA
PRODUCT:
LUPRON DEPOT
MANUFACTURER:
TAP
FORM:
POWDER FOR SUSPENSION, 4 MONTH
STRENGTH:
30 MG
ROUTE OF ADMIN:
INTRAMUSCULAR
ORANGE BOOK CODE:
ADD'L DESC:
(SRN,PREFIL DUAL CHAMBER)
GENERIC NAME:
LEUPROLIDE ACETATE
NDC:
00300-3683-01
SIZE:
ea
DEA Class:
RX
UNIT DOSE (Y/N):
N
SINGLE SOURCE (Y/N):
Y
REPACKAGER (Y/N):
N
GENERIC (Y/N):
N
Current Pricing Information
PKG
UNIT
EFF. DATE
AWP
2836.79
2836.7900
7/2/2005
DIR
HCFA
Copyright © 2006, Thomson PDR.
Page 3
