Over-the-counter drug · ANDA
Ibuprofen PM (Diphenhydramine citrate, ibuprofen) NDC 21130-623
Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 · Tablet, Film coated · Oral · Safeway
NDC codes
FDA NDC DirectoryProduct NDC (as listed)21130-623Labeler and product segments. Claims need a package NDC.
Product NDC at billing width21130-0623Add the package segment from the table below.
| Package NDC | 11-digit (billing) | Package | Copy |
|---|---|---|---|
| 21130-623-76 | 2113006237621130062376 | 1 BOTTLE in 1 CARTON (21130-623-76) / 120 TABLET, FILM COATED in 1 BOTTLEMarketed from Dec 29, 2025 |
How the 11-digit form is made: The product segment has 3 digits, so one leading zero is added to it (5-3-2 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules
Product information
- Brand name (proprietary)
- Ibuprofen PM
- Generic name (nonproprietary)
- diphenhydramine citrate, ibuprofen
- Active ingredients
- Diphenhydramine citrate — 38 mg/1Ibuprofen — 200 mg/1
- Dosage form
- Tablet, Film coated
- Route
- Oral
- Labeler
- SafewayNDC labeler code 21130
- Product type
- Over-the-counter drug
- Marketing category
- ANDA — Abbreviated New Drug Application (generic)Application ANDA 079113
- Marketing start
- Listing expires
- Other FDA classes
- Non-Steroidal (Chemical structure)Cyclooxygenase Inhibitors (Mechanism)Histamine H1 Receptor Antagonists (Mechanism)
- Identifiers
- Product ID 21130-623_fe3393ad-a18f-40cd-abb4-77fb876bd7aaSPL ID fe3393ad-a18f-40cd-abb4-77fb876bd7aaSPL set ID 57e8f0d7-1f21-4fda-8b21-3caa54fae4e6RxCUI 895664UNII 4OD433S209, WK2XYI10QM
- Pharmacologic class
- Histamine-1 Receptor Antagonist; Nonsteroidal Anti-inflammatory Drug
Billing references
What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.
- HCPCS codeNo match
No HCPCS code in Med-Code's directory. Oral products like this are usually dispensed by a pharmacy and billed by NDC.
- NDC on a medical claim
N421130062376followed by a unit qualifier and the quantityPackage 21130-0623-76. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier
Product label
Current FDA label (SPL), effective .
Indications (excerpt from the label)
Uses • for relief of occasional sleeplessness when associated with minor aches and pains • helps you fall asleep and stay asleep
Excerpt only. Read the full label for complete information.
About NDC 21130-623
- What is NDC 21130-623?
- 21130-623 is the product NDC for Ibuprofen PM, Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 tablet, film coated, listed with the FDA by Safeway. It has 1 package NDC, shown above in 10- and 11-digit form.
- What drug is associated with this NDC?
- Ibuprofen PM (Diphenhydramine citrate, ibuprofen).
- What is the active ingredient?
- Diphenhydramine citrate, Ibuprofen.
- Who is the labeler?
- Safeway, NDC labeler code 21130. The labeler is the company responsible for the label; it may be the manufacturer, a repackager or a distributor.
- What other NDCs exist for Ibuprofen PM?
- 24 other product NDCs are listed under this name. See all Ibuprofen PM NDCs.
- Is there a related HCPCS / J-code?
- Not in Med-Code's curated HCPCS directory. See Billing references above.
Related NDCs: other Ibuprofen PM products
Other finished products listed under the same name: strengths, forms and labelers.
| Product | Strength | Form · route | Labeler | Product NDC | Package NDCs (11-digit) |
|---|---|---|---|---|---|
| Ibuprofen PMibuprofen and diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | Whole Foods Market, INC. | 42681-0061 | 42681-0061-01 |
| Ibuprofen PMibuprofen, diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | HEB | 59640-020 | 59640-0020-15 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | WR Group, Inc. | 69607-1970 | 69607-1970-01 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | WALMART INC. (see also Equate) | 79903-186 | 79903-0186-2079903-0186-80 |
| Ibuprofen PMibuprofen and diphenhydramine citrate | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | KROGER COMPANY | 30142-278 | 30142-0278-80 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | Safeway, Inc. | 21130-056 | 21130-0056-4021130-0056-80 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | Family Dollar (FAMILY WELLNESS) | 55319-197 | 55319-0197-2055319-0197-40 |
| Ibuprofen PMibuprofen, diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | CVS Pharmacy | 69842-870 | 69842-0870-15 |
| Ibuprofen PMibuprofen, diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | TOP CARE (Topco Associates LLC) | 36800-237 | 36800-0237-15 |
| Ibuprofen PMibuprofen, diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | KROGER COMPANY | 30142-232 | 30142-0232-1530142-0232-78 |
Other NDCs under ANDA 079113
Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.
| Product | Strength | Form · route | Labeler | Product NDC |
|---|---|---|---|---|
| basic care ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Amazon.com Services LLC | 72288-050 |
| Care One Ibuprofen PMdiphenhydramine citrate and ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | American Sales Company | 41520-050 |
| dg health Ibuprofen pmdiphenhydramine citrate and ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Dolgencorp Inc | 55910-050 |
| equaline ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | United Natural Foods, Inc. dba UNFI | 41163-050 |
| equate ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Wal-Mart Stores Inc | 49035-699 |
| Exchange Select Ibuprofen PMdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Army & Air Force Exchange Service | 55301-050 |
| foster and thrive ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Strategic Sourcing Services LLC | 70677-1131 |
| good neighbor pharmacy ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Amerisource Bergen | 46122-708 |
| good sense ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | L. Perrigo Company | 0113-0050 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Walgreen Company | 0363-0050 |
| ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Rite Aid Corporation | 11822-0050 |
| ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Kroger Company | 30142-050 |
| ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | H E B | 37808-703 |
| Ibuprofen PMdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Meijer Distribution Inc | 41250-050 |
| ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | HyVee Inc | 42507-050 |
| ibuprofen pmdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Publix Super Markets Inc | 56062-050 |
| ibuprofen pmdiphenhydramine citrate and ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | CVS Pharmacy | 59779-050 |
| Leader Ibuprofen PMdiphenhydramine citrate, ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Cardinal Health 110, LLC. dba Leader | 70000-0157 |
| Motrin PMibuprofen and diphenhydramine citrate | Ibuprofen 200 mg/1; Diphenhydramine citrate 38 mg/1 | Tablet, CoatedOral | Kenvue Brands LLC | 50580-563 |
| Topcare Ibuprofen PMdiphenhydramine citrate and ibuprofen | Diphenhydramine citrate 38 mg/1; Ibuprofen 200 mg/1 | Tablet, Film coatedOral | Topco Associates LLC | 36800-050 |
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