Over-the-counter drug · ANDA

cough dm (Dextromethorphan polistirex) NDC 30142-494

Dextromethorphan hydrobromide 30 mg/5mL · Suspension, Extended release · Oral · Kroger Company

NDC codes

FDA NDC Directory
Product NDC (as listed)30142-494Labeler and product segments. Claims need a package NDC.
Product NDC at billing width30142-0494Add the package segment from the table below.
Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC11-digit (billing)PackageCopy
30142-494-2130142049421301420494211 BOTTLE in 1 CARTON (30142-494-21) / 89 mL in 1 BOTTLEMarketed from Jun 28, 2018

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)
cough dm
Generic name (nonproprietary)
dextromethorphan polistirex
Active ingredients
Dextromethorphan hydrobromide — 30 mg/5mL
Dosage form
Suspension, Extended release
Route
Oral
Labeler
Kroger CompanyNDC labeler code 30142
Product type
Over-the-counter drug
Marketing category
ANDA — Abbreviated New Drug Application (generic)Application ANDA 091135
Marketing start
Listing expires
Other FDA classes
Sigma-1 Receptor Agonists (Mechanism)Uncompetitive NMDA Receptor Antagonists (Mechanism)
Identifiers
Product ID 30142-494_aea373dd-40a8-4337-baf1-4dfd48439484SPL ID aea373dd-40a8-4337-baf1-4dfd48439484
Pharmacologic class
Sigma-1 Agonist; Uncompetitive N-methyl-D-aspartate Receptor Antagonist

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

N430142049421 followed by a unit qualifier and the quantity

Package 30142-0494-21. 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

The FDA listing for this product does not reference a label (SPL) set.

About NDC 30142-494

What is NDC 30142-494?
30142-494 is the product NDC for cough dm (dextromethorphan polistirex), Dextromethorphan hydrobromide 30 mg/5mL suspension, extended release, listed with the FDA by Kroger Company. It has 1 package NDC, shown above in 10- and 11-digit form.
What drug is associated with this NDC?
cough dm (Dextromethorphan polistirex).
What is the active ingredient?
Dextromethorphan hydrobromide.
Who is the labeler?
Kroger Company, NDC labeler code 30142. The labeler is the company responsible for the label; it may be the manufacturer, a repackager or a distributor.
What other NDCs exist for cough dm?
18 other product NDCs are listed under this name. See all cough dm NDCs.
Is there a related HCPCS / J-code?
Not in Med-Code's curated HCPCS directory. See Billing references above.

Other finished products listed under the same name: strengths, forms and labelers.

Other cough dm NDCs
ProductStrengthForm · routeLabelerProduct NDCPackage NDCs (11-digit)
cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralAmazon.com Services LLC72288-38972288-0389-28
cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmazon.com Services LLC72288-65272288-0652-28
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralSafeway21130-53821130-0538-21
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralWalgreen Company0363-049400363-0494-28
cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralHyVee Inc42507-49442507-0494-21
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralCVS Pharmacy59779-70959779-0709-2159779-0709-28
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralMeijer Distribution Inc41250-49441250-0494-28
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralPublix Super Markets Inc56062-38456062-0384-21
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralCVS Pharmacy59779-95859779-0958-2159779-0958-28
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralMeijer Distribution Inc41250-95841250-0958-28

All 19 cough dm NDCs

Other NDCs under ANDA 091135

Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.

FDA NDC Directory listings under ANDA 091135
ProductStrengthForm · routeLabelerProduct NDC
12 Hr Relief Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralCVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED51316-263
12 hr relief cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralCVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED51316-943
basic care childrens cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmazon.com Services LLC72288-899
basic care childrens cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmazon.com Services LLC72288-958
basic care cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmazon.com Services LLC72288-384
basic care cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralAmazon.com Services LLC72288-494
CareOne Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmerican Sales Company41520-384
CareOne Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralAmerican Sales Company41520-958
Childrens 12 Hr Cough Reliefdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralCVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED51316-429
childrens cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralWalgreen Company0363-0899
Childrens Robitussin 12 Hour Cough Reliefdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralHaleon US Holdings LLC0031-8725
Childrens Robitussin 12 Hour Cough Reliefdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralHaleon US Holdings LLC0031-8726
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralWalgreen Company0363-0384
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspension, Extended releaseOralWalgreen Company0363-0494
cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralMajor Pharmaceuticals0904-6312
cough dmdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralATLANTIC BIOLOGICALS CORP.17856-6312
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralSafeway21130-538
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralKroger Company30142-384
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralH E B37808-384
Cough DMdextromethorphan polistirexDextromethorphan hydrobromide 30 mg/5mLSuspensionOralMeijer Distribution Inc41250-384

Showing 20 of 39.

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