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Product

Size

ManufacturerMfgr

NDC#

Code*

VIP

340B

Product: Acetaminophen Injection IV ²
Prescribing Information

Size: 500 mg/50 mL (10 mg/mL) Container 24 Case

Manufacturer: B. Braun Medical

NDC#: 00264-4050-80

Code*: J0131

VIPVIP

340BYes

Product: Acetaminophen Injection IV ²
Prescribing Information

Size: 1000 mg/100 mL (10 mg/mL) Container 24 Per Case

Manufacturer: B. Braun Medical

NDC#: 00264-4100-90

Code*: J0131

VIPVIP

340BYes

Product: AKLIEF^® Cream ²
Prescribing Information

Size: 45 gm Pump

Manufacturer: Galderma

NDC#: 00299-5935-45

Code*: J3490

VIPTBD

340BYes

Product: Albutein^® 5% FlexBag™
Prescribing Information

Size: 12.5 gm/250 mL Liquid Bag

Manufacturer: Grifols

NDC#: 68516-5214-09

Code*: P9045

VIPNo

340BNo

Product: Albutein^® 5% FlexBag™
Prescribing Information

Size: 12.5 gm/500 mL Liquid Bag

Manufacturer: Grifols

NDC#: 68516-5214-00

Code*: P9045

VIPNo

340BNo

Product: Albutein^® 25% FlexBag™
Prescribing Information

Size: 12.5 gm/50 mL Liquid Bag

Manufacturer: Grifols

NDC#: 68516-5216-07

Code*: P9047

VIPNo

340BYes

Product: Albutein^® 25% FlexBag™
Prescribing Information

Size: 25 gm/100 mL Liquid Bag

Manufacturer: Grifols

NDC#: 68516-5216-08

Code*: P9047

VIPNo

340BYes

Product: ANAVIP^®
Prescribing Information

Size: 12 mg/20 mL Single-dose Vial

Manufacturer: Rare Disease Therapeutics

NDC#: 66621-0790-02

Code*: J0841

VIPVIP

340BYes

Product: Atropine Sulfate ¹
Prescribing Information

Size: 1 mg/mL 10 mL Luer-Jet™ Luer-Lock Pre-Filled Syringe 10 Pack

Manufacturer: International Medication Systems

NDC#: 76329-3340-01

Code*: J0461

VIPNo

340BYes

Product: Calcitonin Salmon
Prescribing Information

Size: 2 mL (400 USP) Multi-dose Vial

Manufacturer: Leucadia Pharmaceuticals

NDC#: 24201-0400-02

Code*: J0630

VIPVIP

340BNo

Product: Cefazolin ¹
Prescribing Information

Size: 1 gm/10 mL Single-dose Vial 25 Pack

Manufacturer: Apotex

NDC#: 60505-6142-05

Code*: J0690

VIPNo

340BYes

Product: Cefazolin ¹
Prescribing Information

Size: 10 gm/100 mL Single-dose Vial 10 Pack

Manufacturer: Apotex

NDC#: 60505-6143-04

Code*: J0690

VIPNo

340BYes

Product: Cefepime ¹
Prescribing Information

Size: 1 gm/20 mL Single-dose Vial

Manufacturer: Apotex

NDC#: 60505-6146-00

Code*: J0692

VIPNo

340BYes

Product: Cefepime ¹
Prescribing Information

Size: 2 gm/20 mL Single-dose Vial

Manufacturer: Apotex

NDC#: 60505-6147-00

Code*: J0692

VIPNo

340BYes

Product: Cefepime ¹
Prescribing Information

Size: 1 gm/20 mL Single-dose Vial Box of 10

Manufacturer: Apotex

NDC#: 60505-6146-04

Code*: J0692

VIPNo

340BYes

Product: Cefepime ¹
Prescribing Information

Size: 2 gm/20 mL Single-dose Vial Box of 10

Manufacturer: Apotex

NDC#: 60505-6147-04

Code*: J0692

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 1 gm/20 mL Single-dose Vial 10 Pack

Manufacturer: Apotex

NDC#: 60505-6148-04

Code*: J0696

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 2 gm/20 mL Single-dose Vial 10 Pack

Manufacturer: Apotex

NDC#: 60505-6149-04

Code*: J0696

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 250 mg/10 mL Single-dose Vial

Manufacturer: Apotex

NDC#: 60505-6151-04

Code*: J0696

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 250 mg/10 mL Single-dose Vial 10 Pack

Manufacturer: Apotex

NDC#: 60505-6151-01

Code*: J0696

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 500 mg/10 mL Single-dose Vial

Manufacturer: Apotex

NDC#: 60505-6152-04

Code*: J0696

VIPNo

340BYes

Product: Ceftriaxone ¹
Prescribing Information

Size: 500 mg/10 mL Single-dose Vial 10 Pack

Manufacturer: Apotex

NDC#: 60505-6152-01

Code*: J0696

VIPNo

340BYes

Product: CLOBEX^® Lotion 0.05% ²
Prescribing Information

Size: 4 fl oz (118 mL) Bottle

Manufacturer: Galderma

NDC#: 00299-3848-04

Code*: J3490

VIPNo

340BYes

Product: CLOBEX^® Shampoo 0.05% ²
Prescribing Information

Size: 4 fl oz (118 mL) Bottle

Manufacturer: Galderma

NDC#: 00299-3847-04

Code*: J3490

VIPNo

340BYes

Product: CLOBEX^® Spray 0.05% ²
Prescribing Information

Size: 4.25 fl oz (125 mL) Bottle

Manufacturer: Galderma

NDC#: 00299-3849-04

Code*: J3490

VIPNo

340BYes

Product: CUTAQUIG^® 16.5% ²
Prescribing Information

Size: 1 gm 6 mL Single-dose Vial

Manufacturer: Pfizer

NDC#: 00069-1061-02

Code*: 90284 /J3590

VIPNo

340BNo

Product: CUTAQUIG^® 16.5% ²
Prescribing Information

Size: 2 gm 12 mL Single-dose Vial

Manufacturer: Pfizer

NDC#: 00069-1476-02

Code*: 90284 /J3590

VIPNo

340BNo

Product: CUTAQUIG^® 16.5% ²
Prescribing Information

Size: 4 gm 24 mL Single-dose Vial

Manufacturer: Pfizer

NDC#: 00069-1509-02

Code*: 90284 /J3590

VIPNo

340BNo

Product: CUTAQUIG^® 16.5% ²
Prescribing Information

Size: 8 gm 48 mL Single-dose Vial

Manufacturer: Pfizer

NDC#: 00069-1965-02

Code*: 90284 /J3590

VIPNo

340BNo

Product: Doxycycline
Prescribing Information

Size: 40 mg Capsule Bottle of 30

Manufacturer: Presco Laboratories

NDC#: 66993-0815-30

Code*: TBD

VIPNo

340BYes

Product: Dehydrated Alcohol
Prescribing Information

Size: 5 mL (0.98 mL/1 mL) Multi-dose Vial Box of 10

Manufacturer: Akorn Pharmaceuticals

NDC#: 17478-0503-05

Code*: J3490

VIPNo

340BYes

Product: Dextrose
Prescribing Information

Size: 50% 25 gm/50 mL Pre-filled Syringe

Manufacturer: International Medication Systems

NDC#: 76329-3301-01

Code*: J3490

VIPNo

340BYes

Product: Diazepam ¹
Prescribing Information

Size: 10 mg/2 mL Single-dose Carpuject™ Syringe Pack of 10

Manufacturer: Pfizer

NDC#: 00409-1273-32

Code*: J3360

VIPNo

340BYes

Product: Diazepam ¹
Prescribing Information

Size: 50 mg/10 mL Multi-dose Fliptop Vial Box of 10

Manufacturer: Pfizer

NDC#: 00409-3213-12

Code*: J3360

VIPNo

340BYes

Product: DIFFERIN^® Lotion 0.1% ²
Prescribing Information

Size: 2 fl oz (59 mL) Pump Bottle

Manufacturer: Galderma

NDC#: 00299-5912-02

Code*: J3490

VIPNo

340BYes

Product: DIFFERIN^® Cream 0.1% ²
Prescribing Information

Size: 45 gm Tube

Manufacturer: Galderma

NDC#: 00299-5915-45

Code*: J3490

VIPNo

340BYes

Product: DIFFERIN^® Gel 0.3% ²
Prescribing Information

Size: 45 gm Pump

Manufacturer: Galderma

NDC#: 00299-5918-25

Code*: J3490

VIPNo

340BYes

Product: Dilaudid^® Injection ¹
Prescribing Information

Size: 0.2 mg/1 mL Single-dose Pre-filled Syringe 10 Box

Manufacturer: Fresenius Kabi

NDC#: 76045-0121-11

Code*: J1170

VIPNo

340BYes

Product: Docetaxel Injection
Prescribing Information

Size: 20 mg/1 mL Single-dose Vial

Manufacturer: Hospira

NDC#: 00409-0366-01

Code*: J9171

VIPNo

340BYes

Product: Docetaxel Injection
Prescribing Information

Size: 160 mg/8 mL Single-dose Vial

Manufacturer: Hospira

NDC#: 00409-0368-01

Code*: J9171

VIPNo

340BYes

Product: EPIDUO FORTE Gel ²
Prescribing Information

Size: 45 gm Pump

Manufacturer: Galderma

NDC#: 00299-5906-45

Code*: TBD

VIPTBD

340BYes

Product: ESPEROCT^®
Prescribing Information

Size: 500 mcg (4 mL) Syringe

Manufacturer: Novo Nordisk

NDC#: 00169-8500-01

Code*: J7199

VIPNo

340BYes

Product: ESPEROCT^®
Prescribing Information

Size: 1000 mcg (4 mL) Syringe

Manufacturer: Novo Nordisk

NDC#: 00169-8100-01

Code*: J7199

VIPNo

340BYes

Product: ESPEROCT^®
Prescribing Information

Size: 1500 mcg (4 mL) Syringe

Manufacturer: Novo Nordisk

NDC#: 00169-8150-01

Code*: J7199

VIPNo

340BYes

Product: ESPEROCT^®
Prescribing Information

Size: 2000 mcg (4 mL) Syringe

Manufacturer: Novo Nordisk

NDC#: 00169-8200-01

Code*: J7199

VIPNo

340BYes

Product: ESPEROCT^®
Prescribing Information

Size: 3000 mcg (4 mL) Syringe

Manufacturer: Novo Nordisk

NDC#: 00169-8300-01

Code*: J7199

VIPNo

340BYes

Product: EVKEEZA™
Prescribing Information

Size: 345 mg/2.3 mL (150 mg/mL) Single-dose Vial

Manufacturer: Regeneron

NDC#: 61755-0013-01

Code*: TBD

VIPNo

340BYes

Product: EVKEEZA™
Prescribing Information

Size: 1200 mg/8 mL (150 mg/mL) Single-dose Vial

Manufacturer: Regeneron

NDC#: 61755-0010-01

Code*: TBD

VIPNo

340BYes

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

VIPNo

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

VIPNo

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

VIPNo

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

VIPNo

340BYes

Product: Fluad^® Quadrivalent
Prescribing Information

Size: 0.5 mL Pre-Filled Syringe Box of 10

Manufacturer: Seqirus

NDC#: 70461-0120-03

Code*: 90653

VIPNo

340BTBD

Product: GEL-FLOW™
Prescribing Information

Size: JMI 5000 IU Spray Kit (With Thrombin)

Manufacturer: Pfizer

NDC#: 00009-1040-06

Code*: J3490

VIPNo

340BNo

Product: GEL-FLOW™ NT
Prescribing Information

Size: 6 mL (Box/6 Kits) (No Thrombin)

Manufacturer: Pfizer

NDC#: 00009-2250-01

Code*: J3590

VIPNo

340BNo

Product: Imovax^® Rabies
Prescribing Information

Size: 1 mL Single-dose Vial w/diluent

Manufacturer: Sanofi Pasteur

NDC#: 49281-0252-51

Code*: 90675

VIPVIP

340BNo

Product: IXINITY^®
Prescribing Information

Size: 500 IU Range Single-dose Vial

Manufacturer: Medexus

NDC#: 70504-0282-05

Code*: J7195

VIPVIP

340BYes

Product: IXINITY^®
Prescribing Information

Size: 1000 IU Range Single-dose Vial

Manufacturer: Medexus

NDC#: 70504-0283-05

Code*: J7195

VIPVIP

340BYes

Product: IXINITY^®
Prescribing Information

Size: 1500 IU Range Single-dose Vial

Manufacturer: Medexus

NDC#: 70504-0284-05

Code*: J7195

VIPVIP

340BYes

Product: IXINITY^®
Prescribing Information

Size: 3000 IU Range Single-dose Vial

Manufacturer: Medexus

NDC#: 70504-0289-05

Code*: J7195

VIPVIP

340BYes

Product: Ketorolac Tromethamine
Prescribing Information

Size: 30 mg/1 mL Single-dose Vial 25 Carton

Manufacturer: Almaject

NDC#: 72611-0722-25

Code*: J1885

VIPNo

340BNo

Product: Lidocaine HCL
Prescribing Information

Size: 2% Hydrochloride 100 mg 5 mL (20 mg/mL) Pre-filled Syringe

Manufacturer: International Medication Systems

NDC#: 76329-3390-01

Code*: J3490

VIPNo

340BYes

Product: Labetalol ¹
Prescribing Information

Size: 20 mg/4 mL Single-dose Carpuject™ Syringe Pack of 10
(250 mg/mL)

Manufacturer: Pfizer

NDC#: 00409-2339-04

Code*: J3490

VIPNo

340BYes

Product: Lorazepam ¹
Prescribing Information

Size: 2 mg/1 mL Single-dose CARPUJECT™ Syringe System 10 Pack

Manufacturer: Pfizer

NDC#: 00409-1985-03

Code*: J2060

VIPNo

340BYes

Product: MIRVASO^® Gel 0.33% ²
Prescribing Information

Size: 30 gm Pump

Manufacturer: Galderma

NDC#: 00299-5980-35

Code*: J3490

VIPNo

340BYes

Product: Nabi-HB^®
Prescribing Information

Size: 1 mL Single-dose Vial

Manufacturer: ADMA Biologics

NDC#: 69800-4202-01

Code*: 90371

VIPVIP

340BYes

Product: Nabi-HB^®
Prescribing Information

Size: 5 mL Single-dose Vial

Manufacturer: ADMA Biologics

NDC#: 69800-4203-01

Code*: 90371

VIPVIP

340BYes

Product: Novoeight^® ^†
Prescribing Information

Size: 2000 IU Vial

Manufacturer: Novo Nordisk

NDC#: 00169-7820-01

Code*: J7182

VIPVIP

340BYes

Product: NUWIQ^® ^†
Prescribing Information

Size: 2500 IU Single-dose Vial

Manufacturer: Octapharma

NDC#: 68982-0147-01

Code*: J7209

VIPVIP

340BYes

Product: NUWIQ^® ^†
Prescribing Information

Size: 3000 IU Single-dose Vial

Manufacturer: Octapharma

NDC#: 68982-0149-01

Code*: J7209

VIPVIP

340BYes

Product: NUWIQ^® ^†
Prescribing Information

Size: 4000 IU Single-dose Vial

Manufacturer: Octapharma

NDC#: 68982-0151-01

Code*: J7209

VIPVIP

340BYes

Product: ORACEA ²
Prescribing Information

Size: 40 mg Capsule Bottle of 30

Manufacturer: Galderma

NDC#: 00299-3822-30

Code*: TBD

VIPTBD

340BYes

Product: Potassium Acetate
Prescribing Information

Size: 40 mEq/20 mL Single-Dose Fliptop Vial 25 Carton

Manufacturer: Exela

NDC#: 51754-2001-04

Code*: TBD

VIPTBD

340BYes

Product: PREVNAR 20™
Prescribing Information

Size: 0.5 mL Pre-filled Syringe

Manufacturer: Pfizer

NDC#: 00005-2000-02

Code*: 90677

VIPVIP

340BNo

Product: PREVNAR 20™
Prescribing Information

Size: 0.5 mL Pre-filled Syringe 10 Pack

Manufacturer: Pfizer

NDC#: 00005-2000-10

Code*: 90677

VIPVIP

340BNo

Product: Pyrimethamine
Prescribing Information

Size: 25 mg Tablet 100 Bottle

Manufacturer: Alvogen

NDC#: 47781-0925-01

Code*: J3490

VIPTBD

340BTBD

Product: Rocuronium Bromide
Prescribing Information

Size: 50 mg/5 mL Multi-dose Vial 10 Carton

Manufacturer: Almaject

NDC#: 72611-0756-10

Code*: J3490

VIPNo

340BNo

Product: Rocuronium Bromide
Prescribing Information

Size: 100 mg/10 mL Multi-dose Vial 10 Carton

Manufacturer: Almaject

NDC#: 72611-0757-10

Code*: J3490

VIPNo

340BNo

Product: Sodium Chloride
Prescribing Information

Size: 0.9% 20 mL Single-dose Vial Box of 25

Manufacturer: Pfizer

NDC#: 00409-4888-20

Code*: A4216

VIPNo

340BYes

Product: Sodium Chloride
Prescribing Information

Size: 0.9% 50 mL Single-dose Vial Box of 25

Manufacturer: Pfizer

NDC#: 00409-4888-50

Code*: A4216

VIPNo

340BYes

Product: Sodium Tetradecyl Sulfate 3%
Prescribing Information

Size: 60 mg/2 mL (30 mg/mL) Vial 5 Box

Manufacturer: Leucadia Pharmaceuticals

NDC#: 24201-0201-05

Code*: J3490

VIPVIP

340BYes

Product: SOOLANTRA ²
Prescribing Information

Size: 45 gm Tube

Manufacturer: Galderma

NDC#: 00299-3823-45

Code*: TBD

VIPTBD

340BYes

Product: Tamiflu^®
Prescribing Information

Size: 30 mg Capsules 10 Pack

Manufacturer: Genentech

NDC#: 00004-0802-85

Code*: G9035/G9019

VIPNo

340BYes

Product: Tamiflu^®
Prescribing Information

Size: 45 mg Capsules 10 Pack

Manufacturer: Genentech

NDC#: 00004-0801-85

Code*: G9035/G9019

VIPNo

340BYes

Product: TrophAmine^® 10%
Prescribing Information

Size: 500 mL Flexible Plastic Bag 12 Case

Manufacturer: B. Braun Medical

NDC#: 00264-1933-10

Code*: TBD

VIPNo

340BYes

Product: TRI-LUMA^® Cream ²
Prescribing Information

Size: 30 gm Aluminum Tube (0.01%/4%/0.05%)

Manufacturer: Galderma

NDC#: 00299-5950-30

Code*: J3490

VIPNo

340BYes

Product: VECTICAL^® Ointment ²
Prescribing Information

Size: 3 mcg/1 gm 100 gm Tube

Manufacturer: Galderma

NDC#: 00299-2012-10

Code*: J3490

VIPNo

340BYes

Product: VAXELIS™
Prescribing Information

Size: 0.5 mL Pre-filled Syringe 10 Pack

Manufacturer: Sanofi Pasteur

NDC#: 63361-0243-15

Code*: 90697

VIPTBD

340BTBD

Product: VAXELIS™
Prescribing Information

Size: 0.5 mL Single-dose Vial 10 Pack

Manufacturer: Sanofi Pasteur

NDC#: 63361-0243-10

Code*: 90697

VIPTBD

340BTBD

Product: XERAVA™
Prescribing Information

Size: 100 mg/10 mL Single-dose Vial 12 Pack

Manufacturer: Tetraphase Pharmaceuticals

NDC#: 71773-0100-12

Code*: J0122

VIPVIP

340BYes

Product: YUTIQ™
Prescribing Information

Size: YUTIQ 0.18 mg Intravitreal Injection

Manufacturer: Eyepoint Pharmaceuticals

NDC#: 71879-0136-01

Code*: J7314

VIPNo

340BYes

Product: ZILRETTA^®
Prescribing Information

Size: 32 mg Single-dose Kit

Manufacturer: Flexion Therapeutics

NDC#: 70801-0003-01

Code*: J3304

VIPVIP

340BYes

^* All codes should be verified between the provider and the payer.
¹ Call for eligibility through your GPO affiliation.
² Call for eligibility.
⁺Call (800) 843-7477 or check ordering screen for RCo values.
VIP - Verified Inventory Program™ (VIPc)^® | 340B - Public Health Services 340B Pricing Available.

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