Controlled Substance Products

Narcotics and Schedule II Controlled Drugs

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Product
Size
ManufacturerMfgr
NDC#
Code*
RNI
340B
Analgesic Narcotic
Product: Dilaudid® Injection 1
Prescribing Information
Size: 0.2 mg/1 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0121-11
Code*: J1170
RNINo
340BYes
Product: Dilaudid® Injection 1
Prescribing Information
Size: 0.5 mg/0.5 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0009-06
Code*: J1170
RNINo
340BYes
Product: Dilaudid® Injection 1
Prescribing Information
Size: 1 mg/1 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0009-11
Code*: J1170
RNINo
340BYes
Product: Dilaudid® Injection 1
Prescribing Information
Size: 2 mg/1 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0010-11
Code*: J1170
RNINo
340BYes
Product: Fentanyl Citrate Injection
Prescribing Information
Size: 50 mcg 1 mL Single-dose Pre-filled Syringe
Manufacturer: Fresenius Kabi
NDC#: 63323-0808-11
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 50 mcg 1 mL Single-dose Vial 25 Count
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6247-25
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 100 mcg 2 mL Single-dose Vial 25 Count
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6027-25
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection
Prescribing Information
Size: 250 mcg 5 mL Single-dose Vial Count of 10
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6028-10
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 1,000 mcg 20 mL Single-dose Vial
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6029-01
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 2,500 mcg 50 mL Single-dose Vial
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6030-01
Code*: J3010
RNINo
340BTBD
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 500 mcg/10 mL Single-dose Fliptop Vial Box of 25
Manufacturer: Pfizer
NDC#: 00409-9094-28
Code*: J3010
RNINo
340BYes
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 1000 mcg/20 mL Single-dose Fliptop Vial Box of 25
Manufacturer: Pfizer
NDC#: 00409-9094-31
Code*: J3010
RNINo
340BYes
Product: Fentanyl Citrate Injection 1
Prescribing Information
Size: 2500 mcg/50 mL Single-dose Fliptop Vial Box of 25
Manufacturer: Pfizer
NDC#: 00409-9094-61
Code*: J3010
RNINo
340BYes
Product: Morphine Sulfate Injection 1
Prescribing Information
Size: 2 mg/1 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0004-11
Code*: J2270
RNINo
340BYes
Product: Morphine Sulfate Injection 1
Prescribing Information
Size: 4 mg/1 mL Single-dose Pre-filled Syringe Box of 10
Manufacturer: Fresenius Kabi
NDC#: 76045-0005-11
Code*: J2270
RNINo
340BYes
Product: RoxyBond™ (Oxycodone Hydrochloride)1
Prescribing Information
Size: 5 mg Coated Tablets Bottle of 100
Manufacturer: Protega Pharmaceuticals
NDC#: 81140-0101-10
Code*: J8499
RNINo
340BNo
Product: RoxyBond™ (Oxycodone Hydrochloride)1
Prescribing Information
Size: 10 mg Coated Tablets Bottle of 100
Manufacturer: Protega Pharmaceuticals
NDC#: 81140-0104-10
Code*: J8499
RNINo
340BNo
Product: RoxyBond™ (Oxycodone Hydrochloride)1
Prescribing Information
Size: 15 mg Coated Tablets Bottle of 100
Manufacturer: Protega Pharmaceuticals
NDC#: 81140-0102-10
Code*: J8499
RNINo
340BNo
Product: RoxyBond™ (Oxycodone Hydrochloride)1
Prescribing Information
Size: 30 mg Coated Tablets Bottle of 100
Manufacturer: Protega Pharmaceuticals
NDC#: 81140-0103-10
Code*: J8499
RNINo
340BNo
Anesthetic (General Nonbarbiturate)
Product: Ketamine Hydrochloride Injection
Prescribing Information
Size: 200 mg 20 mL (10 mg/mL) Multiple-dose Vial Pack of 10
Manufacturer: Fresenius Kabi
NDC#: 65219-0184-20
Code*: J3490
RNINo
340BYes
Product: Ketamine Hydrochloride Injection
Prescribing Information
Size: 500 mg 5 mL (100 mg/mL) Multiple-dose Vial Box of 10
Manufacturer: Fresenius Kabi
NDC#: 65219-0186-05
Code*: J3490
RNINo
340BYes
Product: Ketamine Hydrochloride Injection
Prescribing Information
Size: 500 mg 10 mL (50 mg/mL) Multiple-dose Vial Box of 10
Manufacturer: Fresenius Kabi
NDC#: 65219-0188-10
Code*: J3490
RNINo
340BYes
Anxiolytic / Sedative
Product: Diazepam Injection 1
Prescribing Information
Size: 10 mg/2 mL Single-dose Carpuject™ Syringe Pack of 10
Manufacturer: Pfizer
NDC#: 00409-1273-32
Code*: J3360
RNINo
340BYes
Product: Diazepam Injection 1
Prescribing Information
Size: 10 mg/2 mL Pre-filled Syringe Carton of 24
Manufacturer: Fresenius Kabi
NDC#: 76045-0204-20
Code*: J3360
RNINo
340BYes
Product: Lorazepam Injection 1
Prescribing Information
Size: 1 mL (2 mg/mL) Single-dose Vial Carton of 25
Manufacturer: Fresenius Kabi
NDC#: 65219-0368-02
Code*: J2060
RNINo
340BYes
Product: Lorazepam Injection1
Prescribing Information
Size: 2 mg/1 mL Single-dose Vial - Pack of 25
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6044-25
Code*: J2060
RNINo
340BYes
Central Nervous System (CNS) Stimulant
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 3.1 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0005-30
Code*: J3490
RNINo
340BNo
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 6.3 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0010-30
Code*: J3490
RNINo
340BNo
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 9.4 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0015-30
Code*: J3490
RNINo
340BNo
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 12.5 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0020-30
Code*: J3490
RNINo
340BNo
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 15.7 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0025-30
Code*: J3490
RNINo
340BNo
Product: ADZENYS XR-ODT®
Prescribing Information
Size: 18.8 mg Extended-release Orally Disintegrating Tablet CII (5 Blister Cards/6 Tablets) Carton of 30
Manufacturer: Aytu BioPharma
NDC#: 70165-0030-30
Code*: J3490
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 3.1 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0005-30
Code*: TBD
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 6.3 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0010-30
Code*: TBD
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 9.4 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0015-30
Code*: TBD
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 12.5 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0020-30
Code*: TBD
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 15.7 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0025-30
Code*: TBD
RNINo
340BNo
Product: AMPHETAMINE XR-ODT
Prescribing Information
Size: 18.8 mg Tablets Carton of 30 Tabs
Manufacturer: Aytu BioPharma
NDC#: 62542-0030-30
Code*: TBD
RNINo
340BNo
Product: Cotempla XR-ODT®
Prescribing Information
Size: 8.6 mg Methylphenidate Extended-release Orally Disintegrating Tablet (5 Blister Cards/6 Tablets) Carton of 30 Reusable Travel Case
Manufacturer: Aytu BioPharma
NDC#: 70165-0100-30
Code*: TBD
RNINo
340BNo
Product: Cotempla XR-ODT®
Prescribing Information
Size: 17.3 mg Methylphenidate Extended-release Orally Disintegrating Tablet (5 Blister Cards/6 Tablets) Carton of 30 Reusable Travel Case
Manufacturer: Aytu BioPharma
NDC#: 70165-0200-30
Code*: TBD
RNINo
340BNo
Product: Cotempla XR-ODT®
Prescribing Information
Size: 25.9 mg Methylphenidate Extended-release Orally Disintegrating Tablet (5 Blister Cards/6 Tablets) Carton of 30 Reusable Travel Case
Manufacturer: Aytu BioPharma
NDC#: 70165-0300-30
Code*: TBD
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 10 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0579-30
Code*: J8499
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 20 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0580-30
Code*: J8499
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 30 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0581-30
Code*: J8499
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 40 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0582-30
Code*: J8499
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 50 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0583-30
Code*: J8499
RNINo
340BNo
Product: Metadate CD®
Prescribing Information
Size: 60 mg Extended-release Capsules CII Bottle of 30
Manufacturer: Aytu BioPharma
NDC#: 69654-0584-30
Code*: J8499
RNINo
340BNo
* All codes should be verified between the provider and the payer.
1 Call for eligibility through your GPO affiliation.
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