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 1
Prescribing Information
Size: 250 mcg 5 mL Single-dose Vial 25 Count
Manufacturer: Hikma Pharmaceuticals
NDC#: 00641-6028-25
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: 100 mcg/2 mL Single-dose Fliptop Vial Box of 25
Manufacturer: Pfizer
NDC#: 00409-9094-22
Code*: J3010
RNINo
340BYes
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: Lorazepam  Injection1
Prescribing Information
Size: 2 mg/1 mL Single-dose Cartridge with Luer Lock for CARPUJECT™ Syringe System Pack of 10
Manufacturer: Pfizer
NDC#: 00409-1985-03
Code*: J2060
RNINo
340BYes
Anesthesia
Product: Ketamine Hydrochloride Injection 1
Prescribing Information
Size: 500 mg 5 mL (100 mg/mL) Multiple-dose Vial Pack of 10
Manufacturer: Hikma Pharmaceuticals
NDC#: 00413-9509-10
Code*: J3490
RNINo
340BTBD
Product: Ketamine Hydrochloride Injection 1
Prescribing Information
Size: 500 mg 10 mL (100 mg/mL) Multiple-dose Vial Pack of 10
Manufacturer: Hikma Pharmaceuticals
NDC#: 00413-9508-10
Code*: J3490
RNINo
340BTBD
Product: Ketamine Hydrochloride Injection 1
Prescribing Information
Size: 200 mg/20 mL Multiple-dose Vial Carton of 10
Manufacturer: AuroMedics Pharma
NDC#: 55150-0438-10
Code*: J3490
RNINo
340BYes
Product: Ketamine Hydrochloride Injection 1
Prescribing Information
Size: 1000 mg/10 mL Multiple-dose Vial Carton of 10
Manufacturer: AuroMedics Pharma
NDC#: 55150-0440-10
Code*: J3490
RNINo
340BYes
Anticonvulsant
Product: BRIVIACT®
Prescribing Information
Size: 10 mg Tablet Bottle of 60
Manufacturer: UCB
NDC#: 50474-0370-66
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 25 mg Tablet Bottle of 60
Manufacturer: UCB
NDC#: 50474-0470-66
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 50 mg Tablet Bottle of 60
Manufacturer: UCB
NDC#: 50474-0570-66
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 75 mg Tablet Bottle of 60
Manufacturer: UCB
NDC#: 50474-0670-66
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 100 mg Tablet Bottle of 60
Manufacturer: UCB
NDC#: 50474-0770-66
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 25 mg Tablet Unit Dose Carton of 100 Tablets
Manufacturer: UCB
NDC#: 50474-0470-09
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 50 mg Tablet Unit Dose Carton of 100 Tablets
Manufacturer: UCB
NDC#: 50474-0570-09
Code*: TBD
RNINo
340BYes
Product: BRIVIACT®
Prescribing Information
Size: 100 mg Tablet Unit Dose Carton of 100 Tablets
Manufacturer: UCB
NDC#: 50474-0770-09
Code*: TBD
RNINo
340BYes
Product: BRIVIACT® Oral Solution
Prescribing Information
Size: 10 mg/mL 300 mL Amber Glass Bottle
Manufacturer: UCB
NDC#: 50474-0870-15
Code*: TBD
RNINo
340BYes
Product: BRIVIACT® Injection
Prescribing Information
Size: 50 mg/5 mL Single-dose Glass Vial Carton of 10
Manufacturer: UCB
NDC#: 50474-0970-75
Code*: J3490
RNINo
340BYes
Product: NAYZILAM®
Prescribing Information
Size: 5 mg/0.1 mL Single-dose Nasal Spray Unit Pack of 2
Manufacturer: UCB
NDC#: 50474-0500-15
Code*: J3490
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 50 mg Tablet Bottle of 60 Tablets
Manufacturer: UCB
NDC#: 00131-2477-35
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 50 mg Tablet Unit Dose Carton of 60 Tablets [6 Cards, Each Card Contains 10 Tablets]
Manufacturer: UCB
NDC#: 00131-2477-60
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 100 mg Tablet Bottle of 60 Tablets
Manufacturer: UCB
NDC#: 00131-2478-35
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 100 mg Tablet Unit Dose Carton of 60 Tablets [6 Cards, Each Card Contains 10 Tablets]
Manufacturer: UCB
NDC#: 00131-2478-60
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 150 mg Tablet Bottle of 60 Tablets
Manufacturer: UCB
NDC#: 00131-2479-35
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 150 mg Tablet Unit Dose Carton of 60 Tablets [6 Cards, Each Card Contains 10 Tablets]
Manufacturer: UCB
NDC#: 00131-2479-60
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 200 mg Tablet Bottle of 60 Tablets
Manufacturer: UCB
NDC#: 00131-2480-35
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide)
Prescribing Information
Size: 200 mg Tablet Unit Dose Carton of 60 Tablets [6 Cards, Each Card Contains 10 Tablets]
Manufacturer: UCB
NDC#: 00131-2480-60
Code*: J8499
RNINo
340BYes
Product: VIMPAT® (Lacosamide) Injection
Prescribing Information
Size: 200 mg/20 mL Single-dose Vial Pack of 10
Manufacturer: UCB
NDC#: 00131-1810-67
Code*: C9254/ J3490
RNINo
340BYes
Product: VIMPAT® (Lacosamide) Oral Solution
Prescribing Information
Size: 10 mg/mL 200 mL Glass Bottle
Manufacturer: UCB
NDC#: 00131-5410-72
Code*: J8499
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: 50 mg/10 mL Multi-dose Fliptop Vial Box of 10
Manufacturer: Pfizer
NDC#: 00409-3213-12
Code*: J3360
RNINo
340BYes
* All codes should be verified between the provider and the payer.
1 Call for eligibility through your GPO affiliation.
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