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  4. Vancomycin Injection, USP in 5% Dextrose, 1.25g / 250mL (5mg / mL) in Single Dose GALAXY Container, Frozen Premix
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Vancomycin Injection, USP in 5% Dextrose, 1.25g / 250mL (5mg / mL) in Single Dose GALAXY Container, Frozen Premix
Item Number: 2G3557
GTIN:  00303380122042
GTIN-CS:  20303380122046
Vancomycin Injection, USP in 5% Dextrose, 1.25g / 250mL (5mg / mL) in Single Dose GALAXY Container (4 bags/case), Frozen Premix. NDC 0338-0122-04.
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Specifications

Product Characteristics

Trademark Baxter and Galaxy are trademarks of Baxter International Inc. or its subsidiaries.
Volume 250.0 ml
DEHP Free Yes
PVC Free Yes
Latex Free Yes
Shelf Life from Manufacture 12 months
Concentration 5 mg/mL
Container Type GALAXY
Diluent Dextrose
Dosage Form Frozen
Polyethlene Lined No
Protect From Light No
Rx Only Yes
Storage Recommendations Store at or below -20°C (-4°F). Thawed solution remains stable for 72 hours at room temperature (25°C/77°F) or for 30 days when stored under refrigeration (5°C/41°F). Do not refreeze. Product containers may be fragile in the frozen state.
Strength 1.25g/250mL

Carton

Units per Case 4.0
Carton Weight 2.79 lb.
Carton Length 12.0 in.
Carton Width 5.91 in.
Carton Height 2.5 in.
Carton Volume 177.3 ci

Reimbursement Information

HCPCS Code HCPCS Description
A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML
J3373 INJECTION, VANCOMYCIN HCL, 500 MG
Medication Delivery Reimbursement Hotline 888-338-0001

Information Source : CMS

Disclaimer:The coverage, coding, and payment information included in this guide has been compiled from various resources for informational use as a tool to assist providers with reimbursement issues. This information is current as of 3/31/2008; however this information is subject to change and should not be construed as legal advice. Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect services rendered to individual patients. Baxter Healthcare Corporation does not guarantee success in obtaining insurance payments. Providers are encouraged to contact third-party payors for specific information on their coverage, coding, and payment policies.
Ordering Information
Item Number 2G3557
Sales Unit case
GTIN 00303380122042
GTIN-CS 20303380122046
National Drug Code 0338012204

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