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  5. NDC Package Code: 50242-103-01 Polivy

NDC Package 50242-103-01 Polivy

Polatuzumab Vedotin Injection, Powder, Lyophilized, For Solution Intravenous - View Billable Units, 11-Digit Format, RxNorm

Table of Contents

    1. Package Information
    2. Frequently Asked Questions

Package Information

Find all the important details about this NDC Package code, including the 11-Digit NDC Billing number, billing units, wholesale price, RxNorm crosswalk, active ingredients, pharmacologic clasess, etc.

NDC Package Code:
50242-103-01
Package Description:
1 VIAL in 1 CARTON / 6 mL in 1 VIAL
Product Code:
50242-103
Proprietary Name:
Polivy
Non-Proprietary Name:
Polatuzumab Vedotin
Substance Name:
Polatuzumab Vedotin
Usage Information:
Polatuzumab is used to treat a certain type of lymphoma (diffuse large B-cell lymphoma, also known as DLBCL). This medication works by stopping the growth of cancer cells.
11-Digit NDC Billing Format:
50242010301
NDC to RxNorm Crosswalk:
  • RxCUI: 2174095 - polatuzumab vedotin-piiq 140 MG Injection
  • RxCUI: 2174100 - Polivy 140 MG Injection
  • RxCUI: 2174100 - polatuzumab vedotin-piiq 140 MG Injection [Polivy]
  • RxCUI: 2398131 - olatuzumab vedotin-piiq 30 MG Injection
  • RxCUI: 2398131 - polatuzumab vedotin-piiq 30 MG Injection
    • Product Type:
    Human Prescription Drug
    Labeler Name:
    Genentech, Inc.
    Dosage Form:
    Injection, Powder, Lyophilized, For Solution - A dosage form intended for the solution prepared by lyophilization ("freeze drying"), a process which involves the removal of water from products in the frozen state at extremely low pressures; this is intended for subsequent addition of liquid to create a solution that conforms in all respects to the requirements for Injections.
    Administration Route(s):
  • Intravenous - Administration within or into a vein or veins.
    • Active Ingredient(s):
  • POLATUZUMAB VEDOTIN 30 mg/1.88mL
    • Sample Package:
    No
    FDA Application Number:
    BLA761121
    Marketing Category:
    BLA - A product marketed under an approved Biologic License Application.
    Start Marketing Date:
    06-10-2019
    Listing Expiration Date:
    12-31-2025
    Exclude Flag:
    N
    Code Structure:

    The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

    * Please review the disclaimer below.

    Frequently Asked Questions

    What is NDC 50242-103-01?

    The NDC Packaged Code 50242-103-01 is assigned to a package of 1 vial in 1 carton / 6 ml in 1 vial of Polivy, a human prescription drug labeled by Genentech, Inc.. The product's dosage form is injection, powder, lyophilized, for solution and is administered via intravenous form.

    Is NDC 50242-103 included in the NDC Directory?

    Yes, Polivy with product code 50242-103 is active and included in the NDC Directory. The product was first marketed by Genentech, Inc. on June 10, 2019 and its listing in the NDC Directory is set to expire on December 31, 2025 if the product is not updated or renewed by the manufacturer.

    What is the 11-digit format for NDC 50242-103-01?

    The 11-digit format is 50242010301. The 11-digit billing format might be required by the Centers for Medicare & Medicaid Services (CMS) and other payers in billing claim forms.

    This package code is originally configured in a 5-3-2 segment 10-digit format and by adding a zero within the original NDC package code we can obtain the converted 11-digit format in a 5-4-2 segment configuration. The table below shows the 11-digit code conversion:

    10-Digit Format10-Digit Original Code11-Digit Format11-Digit Code
    5-3-250242-103-015-4-250242-0103-01