Attachment 3 - PPV-G Specialty Drug List 3.27.24.xlsx

specialty items NOTE: The specialty list stated below contains all of the items that DLA would currently consider as specialty pharmaceuticals at the start of the PPVG GEN V contract. This list is subject to change throughout the life of the contract in accordance with the Statement of Work. Some of these specialty pharmaceuticals are currently purchased outside of the PPV program and may not be purchased under the PPVG GEN V contract.

NDC NDC_SHORT_DESCRIPTION UNIT_PACKAGE PACKAGE_SIZE UNIT_OF_MEASURE UNIT_PACK_DESC SPECIALTY_DRUG_IND

00002298026 RETEVMO 80 MG CAPSULE 120S BO 120 EA BOTTLE OF 120 CAPSULE Y

00002397760 RETEVMO 40 MG CAPSULE 60S BO 60 EA BOTTLE OF 60 CAPSULE Y

00002418230 OLUMIANT 2 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00002772411 TALTZ 80 MG/ML SYRINGEML SZ 1 ML SYRINGE OF 1 MILLILITER Y

00002840001 FORTEO 600 MCG/2.4 ML PEN INJ 2.4ML SZ 2.4 ML SYRINGE OF 2.4 MILLILITER Y

00003452211 EMPLICITI 400 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00006022761 ISENTRESS 400 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00006360361 ISENTRESS 100 MG POWDER PACKET 60S 12 60 EA PACKET OF 60 EACH Y

00006386203 EMEND TRIPACK UU 3S PK 3 EA PACKAGE OF 3 CAPSULE Y

00006533101 WELIREG 40 MG TABLET 90S BO 90 EA BOTTLE OF 90 TABLET Y

00008010001 BESPONSA 0.9 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00008117901 TORISEL 25 MG KITML VI 1 ML VIAL OF 1 MILLILITER Y

00008451001 MYLOTARG 4.5 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00009509101 ELLENCE 2 MG/ML VIAL 25ML VI 25 ML VIAL OF 25 MILLILITER Y

00013013202 EMCYT 140 MG CAPSULE 100S BO 100 EA BOTTLE OF 100 CAPSULE Y

00023585801 LILETTA 52 MG SYSTEMS BX 1 EA BOX OF 1 EACH Y

00024582411 JEVTANA 60 MG/1.5 ML KIT 1.5ML VI 1.5 ML VIAL OF 1.5 MILLILITER Y

00025016608 SYNAREL 2 MG/ML NASAL SPRAY 8ML BO 8 ML BOTTLE OF 8 MILLILITER Y

00037440101 DEPEN 250 MG TITRATAB UU 100S BO 100 EA BOTTLE OF 100 TABLET Y

00054006447 ONDANSETRON 4 MG/5 ML SOLUTION 50ML BO 50 ML BOTTLE OF 50 MILLILITER Y

00054008013 EXEMESTANE 25 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00054039925 BEXAROTENE 75 MG CAPSULE 100S BO 100 EA BOTTLE OF 100 CAPSULE Y

00054057625 DEFERIPRONE 500 MG TABLET 100S BO 100 EA BOTTLE OF 100 TABLET Y

00054060421 EVEROLIMUS 1 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00054071119 DEFERIPRONE 1,000 MG TB(3X/DY) 50S BO 50 EA BOTTLE OF 50 TABLET Y

00054849619 LEUCOVORIN CALCIUM 5 MG TAB UD 50S PK 50 EA PACKAGE OF 50 TABLET Y

00069019730 VIZIMPRO 15 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00069022701 LORBRENA 25 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00069023101 LORBRENA 100 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00069153130 DAURISMO 100 MG TABLET 30S BO 30 EA BOTTLE OF 30 TABLET Y

00069419068 REVATIO 20 MG TABLET 90S BO 90 EA BOTTLE OF 90 TABLET Y

00074501501 SKYRIZI 600 MG/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00074679922 KALETRA 200-50 MG TABLET 120S BO 120 EA BOTTLE OF 120 TABLET Y

00074726950 GENGRAF 100 MG/ML SOLUTION 50ML BO 50 ML BOTTLE OF 50 MILLILITER Y

00074969403 LUPRON DEPOT-PED 30 MG 3MO KITS KT 1 EA KIT OF 1 EACH Y

00078033184 SIMULECT 20 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00078043561 RECLAST 5 MG/100 ML SOLUTION 100ML BO 100 ML BOTTLE OF 100 MILLILITER Y

00078052687 TASIGNA 200 MG CAPSULE 28S PK 28 EA PACKAGE OF 28 CAPSULE Y

00078072715 JADENU SPRINKLE 90 MG GRANULE 30S 12 30 EA PACKET OF 30 EACH Y

00078073461 ILARIS 150 MG/ML VIALML VI 1 ML VIAL OF 1 MILLILITER Y

00078081181 SANDOSTATIN LAR DEPOT 10 MG KTS VI 1 EA VIAL OF 1 EACH Y

00078086001 KISQALI 200 MG DAILY DOSE UU 21S PK 21 EA PACKAGE OF 21 TABLET Y

00078095166 TASIGNA 50 MG CAPSULE 120S BO 120 EA BOTTLE OF 120 CAPSULE Y

00078116147 MEKINIST 0.05 MG/ML SOLUTION 90ML BO 90 ML BOTTLE OF 90 MILLILITER Y

00085138101 TEMODAR 100 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00093110616 TERIPARATIDE 600 MCG/2.4ML PEN 2.4ML SZ 2.4 ML SYRINGE OF 2.4 MILLILITER Y

00093333406 ALYQ 20 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00093408563 TOBRAMYCIN 300 MG/5 ML AMPULE UD 5ML AM 5 ML AMPOULE OF 5 MILLILITER Y

00093523456 EFAVIR-EMTRI-TENOF 600-200-300 UU 30S BO 30 EA BOTTLE OF 30 TABLET Y

00093823128 SUNITINIB MALATE 50 MG CAPSULE 28S BO 28 EA BOTTLE OF 28 CAPSULE Y

00143929910 GANCICLOVIR 500 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00143938501 DECITABINE 50 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00143956501 THIOTEPA 15 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00143960601 AZACITIDINE 100 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00143972401 CLONIDINE 1,000 MCG/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00143983001 METHOTREXATE 1 GM VIALS VI 1 EA VIAL OF 1 EACH Y

00143987101 CLADRIBINE 10 MG/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00169701301 TRETTEN 2,500 UNIT VIALS VI 1 EA VIAL OF 1 BOTTLE Y

00172731320 CYCLOSPORINE MODIFIED 100MG/ML 50ML BO 50 ML BOTTLE OF 50 MILLILITER Y

00173066200 EPIVIR HBV 100 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00173088101 NUCALA 100 MG/ML POWDER VIALS VI 1 EA VIAL OF 1 EACH Y

00173090442 NUCALA 40 MG/0.4 ML SYRINGE 0.4ML SZ 0.4 ML SYRINGE OF .4 MILLILITER Y

00187000402 SILIQ 210 MG/1.5 ML SYRINGE 1.5ML SZ 1.5 ML SYRINGE OF 1.5 MILLILITER Y

00187212010 SYPRINE 250 MG CAPSULE 100S BO 100 EA BOTTLE OF 100 CAPSULE Y

00187320447 EFUDEX 5% CREAM 40GM TB 40 GR TUBE OF 40 GRAM Y

00187520030 CARAC 0.5% CREAM 30GM TB 30 GR TUBE OF 30 GRAM Y

00310461150 IMFINZI 500 MG/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00338006301 DOXIL 20 MG/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00338006701 DOXIL 50 MG/25 ML VIAL 25ML VI 25 ML VIAL OF 25 MILLILITER Y

00338072201 PEMETREXED DISODIUM 500 MG VLS VI 1 EA VIAL OF 1 EACH Y

00338130501 MESNEX 1 GRAM/10 ML VIAL 10ML VI 10 ML VIAL OF 10 MILLILITER Y

00378039614 DIMETHYL FUMARATE DR 120 MG CP 14S BO 14 EA BOTTLE OF 14 CAPSULE Y

00378120178 SORAFENIB 200 MG TABLET 120S BO 120 EA BOTTLE OF 120 TABLET Y

00378326694 ETOPOSIDE 50 MG CAPSULE UD 20S PK 20 EA PACKAGE OF 20 CAPSULE Y

00378405091 NEVIRAPINE 200 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00378420278 MYCOPHENOLIC ACID DR 360 MG TB 120S BO 120 EA BOTTLE OF 120 TABLET Y

00378452593 FINGOLIMOD 0.5 MG CAPSULE 30S BO 30 EA BOTTLE OF 30 CAPSULE Y

00378807849 FLUOROURACIL 0.5% CREAM 30GM TB 30 GR TUBE OF 30 GRAM Y

00409080101 NIPENT 10 MG VIALS VI 1 EA VIAL OF 1 EACH Y

00409218801 PEMETREXED DISODIUM 500MG/20ML 20ML VI 20 ML VIAL OF 20 MILLILITER Y

00409233725 DEFEROXAMINE 2 GRAM VIALS VI 1 EA VIAL OF 1 EACH Y

00409353201 PEMETREXED DISODIUM 1 GM/40 ML 40ML VI 40 ML VIAL OF 40 MILLILITER Y

00469012599 XTANDI 40 MG CAPSULE 120S BO 120 EA BOTTLE OF 120 CAPSULE Y

00469301601 PROGRAF 5 MG/ML AMPULEML AM 1 ML AMPOULE OF 1 MILLILITER Y

00480773606 DARUNAVIR 600 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00517430001 PACLITAXEL PROTEIN-BOUND 100MGS VI 1 EA VIAL OF 1 EACH Y

00527194748 LOPINAVIR-RITONAVIR 80-20MG/ML 160ML BO 160 ML BOTTLE OF 160 MILLILITER Y

00527516082 MYCOPHENOLATE 200 MG/ML SUSP 160ML BO 160 ML BOTTLE OF 160 MILLILITER Y

00548500100 GANIRELIX ACET 250 MCG/0.5 ML 0.5ML SZ 0.5 ML SYRINGE OF .5 MILLILITER Y

00591251160 BOSENTAN 62.5 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00591253360 DALFAMPRIDINE ER 10 MG TABLET 60S BO 60 EA BOTTLE OF 60 TABLET Y

00591257920 VALGANCICLOVIR HCL 50 MG/ML 88ML BO 88 ML BOTTLE OF 88 MILLILITER Y

00591283201 BEXAROTENE 75 MG CAPSULE 100S BO 100 EA BOTTLE OF 100 CAPSULE Y

00597000302 APTIVUS 250 MG CAPSULE 120S BO 120 EA BOTTLE OF 120 CAPSULE Y

00597003510 SPEVIGO 450 MG/7.5 ML VIAL 7.5ML VI 7.5 ML VIAL OF 7.5 MILLILITER Y

00703574811 CISPLATIN 100 MG/100 ML VIAL 100ML VI 100 ML VIAL OF 100 MILLILITER Y

00781215832 PIRFENIDONE 267 MG CAPSULE 270S BO 270 EA BOTTLE OF 270 CAPSULE Y

00781307912 FULVESTRANT 250 MG/5 ML SYRING 5ML SZ 5 ML SYRINGE OF 5 MILLILITER Y