NDC codes

FDA NDC Directory
Product NDC (as listed)0363-9330Labeler and product segments. Claims need a package NDC.
Product NDC at billing width00363-9330Add 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
0363-9330-1000363933010100 BLISTER PACK in 1 CARTON (0363-9330-10) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Oct 30, 2020
0363-9330-1600363933016160 BLISTER PACK in 1 CARTON (0363-9330-16) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Oct 30, 2020
0363-9330-200036393302020 BLISTER PACK in 1 CARTON (0363-9330-20) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Oct 30, 2020

How the 11-digit form is made: The labeler segment has 4 digits, so one leading zero is added to it (4-4-2 → 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
Generic name (nonproprietary)
nicotine polacrilex
Active ingredients
Nicotine — 4 mg/1
Dosage form
Gum, Chewing
Route
Oral
Labeler
Walgreens
Product type
Over-the-counter drug
Marketing category
ANDA — Abbreviated New Drug Application (generic)Application ANDA 078697
Marketing start
Marketing end
Other FDA classes
Nicotine (Chemical structure)
Identifiers
Product ID 0363-9330_8c903d99-3418-430d-bac9-a438244b0a06SPL ID 8c903d99-3418-430d-bac9-a438244b0a06SPL set ID 826f63b2-fd18-4213-be38-a430d78897cbRxCUI 311975UNII 6M3C89ZY6RUPC 0311917032764
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. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N400363933010 followed by a unit qualifier and the quantity

Package 00363-9330-10. 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

Label details couldn’t be retrieved right now. Open the label on DailyMed.

Other NDCs under ANDA 078697

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

FDA NDC Directory listings under ANDA 078697
ProductStrengthForm · routeLabelerProduct NDC
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralQuitine LLC84720-933
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingBuccalAAFES/Your Military Exchanges55301-429
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-281
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-285
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralDolgencorp, Inc. (DOLLAR GENERAL & REXALL)55910-976
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-560
Nicotine Polacrilex coated mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalCVS Pharmacy69842-430
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralAmerisourceBergen (Good Neighbor Pharmacy) 4612246122-718
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralRising Pharma Holdings, Inc.57237-323
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralLucy Goods, Inc.72224-933
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalPublix Supermarkets, Inc.56062-429
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalRugby Laboratories0536-3113
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralDolgencorp, Inc. (DOLLAR GENERAL & REXALL)55910-796
Habitrol Nicotine Polacrilex Gum 4 mg Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingOralDr. Reddy's Laboratories Inc.75907-303
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalCARDINAL HEALTH 110, LLC. DBA LEADER 7000070000-0343

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