Over-the-counter drug · ANDA
Nicotine Polacrilex coated ice mint NDC 69842-217
nicotine polacrilex gum · Nicotine 4 mg/1 · Gum, Chewing · Buccal · CVS Pharmacy
NDC codes
FDA NDC Directory| Package NDC | 11-digit (billing) | Package | Copy |
|---|---|---|---|
| 69842-217-15 | 69842021715 | 20 BLISTER PACK in 1 CARTON (69842-217-15) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from May 1, 2016 | |
| 69842-217-16 | 69842021716 | 160 BLISTER PACK in 1 CARTON (69842-217-16) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from May 1, 2016 | |
| 69842-217-44 | 69842021744 | 100 BLISTER PACK in 1 CARTON (69842-217-44) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from May 1, 2016 |
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)
- Nicotine Polacrilex coated ice mintSuffix: coated ice mint
- Generic name (nonproprietary)
- nicotine polacrilex gum
- Active ingredients
- Nicotine — 4 mg/1
- Dosage form
- Gum, Chewing
- Route
- Buccal
- Labeler
- CVS Pharmacy
- Product type
- Over-the-counter drug
- Marketing category
- ANDA — Abbreviated New Drug Application (generic)Application ANDA 204833
- Marketing start
- Listing expires
- Other FDA classes
- Nicotine (Chemical structure)
- Identifiers
- Product ID 69842-217_5f0324e3-b546-4cdc-af4d-e45e2052a179SPL ID 5f0324e3-b546-4cdc-af4d-e45e2052a179SPL set ID e4e3fd5f-1ed1-4a18-9c31-7224cae77dedRxCUI 311975, 314119UNII 6M3C89ZY6R
- Pharmacologic class
- Cholinergic Nicotinic Agonist
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. Buccal products like this are usually dispensed by a pharmacy and billed by NDC.
- NDC on a medical claim
N469842021715followed by a unit qualifier and the quantityPackage 69842-0217-15. 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)
Use reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking
Excerpt only. Read the full label for complete information.
Other NDCs under ANDA 204833
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 |
|---|---|---|---|---|
| Nicotine Polacrilex | Nicotine 4 mg/1 | Gum, ChewingOral | Dolgencorp, Inc. (DOLLAR GENERAL & REXALL) | 55910-933 |
| Nicotine Polacrilex | Nicotine 4 mg/1 | Gum, ChewingBuccal | Chain Drug Consortium, LLC | 68016-293 |
| Nicotine Polacrilex | Nicotine 4 mg/1 | Gum, ChewingOral | Family Dollar (FAMILY WELLNESS) | 55319-966 |
| Nicotine Polacrilex coated ice mintnicotine polacrilex | Nicotine 4 mg/1 | Gum, ChewingBuccal | AmerisourceBergen (Good Neighbor Pharmacy) 46122 | 46122-449 |
| Nicotine Polacrilex Coated Ice Mintnicotine polacrilex | Nicotine 4 mg/1 | Gum, ChewingBuccal | CARDINAL HEALTH 110, LLC. DBA LEADER 70000 | 70000-0344 |
| Nicotine Polacrilex | Nicotine 4 mg/1 | Gum, ChewingOral | Walgreens | 0363-3290 |