Active substance: Cyclosporine
Restasis (Cyclosporine) NDC 0023-9163 converts to 00023-9163-12 for billing. It is dispensed by a pharmacy and billed directly on the NDC — no HCPCS J-code is required.
| Formulation / role | Package NDC | Product NDC | 11-digit HIPAA | Packaging detail | Copy |
|---|---|---|---|---|---|
| .5 mg/mL | 50090-4476-0 | 50090-4476 | 50090-4476-00 | 30 VIAL, SINGLE-USE in 1 TRAY (50090-4476-0) / .4 mL in 1 VIAL, SINGLE-USE | |
| .5 mg/mL | 0023-9163-12 | 0023-9163 | 00023-9163-12 | 5 VIAL, SINGLE-USE in 1 CARTON (0023-9163-12) / .4 mL in 1 VIAL, SINGLE-USESample | |
| .5 mg/mL | 0023-9163-30 | 0023-9163 | 00023-9163-30 | 30 VIAL, SINGLE-USE in 1 TRAY (0023-9163-30) / .4 mL in 1 VIAL, SINGLE-USE | |
| .5 mg/mL | 0023-9163-60 | 0023-9163 | 00023-9163-60 | 60 VIAL, SINGLE-USE in 1 TRAY (0023-9163-60) / .4 mL in 1 VIAL, SINGLE-USE | |
| .5 mg/mL | 0023-5301-05 | 0023-5301 | 00023-5301-05 | 1 BOTTLE in 1 CARTON (0023-5301-05) / 5.5 mL in 1 BOTTLE |
Taken from the manufacturer's FDA Structured Product Labeling submission. This is the label as filed, not a summary.