Prescription drug · UNAPPROVED DRUG OTHER
Dialyvite Supreme D NDC 10542-009
Ascorbic acid 100 mg/1 + 12 more ingredients · Tablet, Coated · Oral · Hillestad Pharmaceuticals USA
NDC codes
FDA NDC Directory| Package NDC | 11-digit (billing) | Package | Copy |
|---|---|---|---|
| 10542-009-02 | 10542000902 | 7 TABLET, COATED in 1 BOTTLE, PLASTIC (10542-009-02)Marketed from Sep 8, 2010 · Sample package | |
| 10542-009-09 | 10542000909 | 90 TABLET, COATED in 1 BOTTLE, PLASTIC (10542-009-09)Marketed from Sep 8, 2010 |
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)
- Dialyvite Supreme D
- Generic name (nonproprietary)
- ascorbic acid, cholecalciferol, alpha-tocopherol, thiamine, riboflavin, niacinamide, pyridoxine, folic acid, cobalamin, biotin, pantothenic acid, zinc, selenium
- Active ingredients
- Ascorbic acid — 100 mg/1Cholecalciferol — 2000 [iU]/1.alpha.-tocopherol succinate, D- — 30 [iU]/1Thiamine mononitrate — 1.5 mg/1Riboflavin — 1.7 mg/1Niacinamide — 20 mg/1Pyridoxine hydrochloride — 25 mg/1Folic acid — 3 mg/1Cobalamin — 1 mg/1Biotin — 300 ug/1Calcium pantothenate — 10 mg/1Zinc citrate — 15 mg/1Selenocysteine — 70 ug/1
- Dosage form
- Tablet, Coated
- Route
- Oral
- Product type
- Prescription drug
- Marketing category
- Unapproved drug (other)
- Marketing start
- Marketing end
- Other FDA classes
- Analogs/Derivatives (Chemical/Ingredient)Ascorbic Acid (Chemical structure)Decreased Copper Ion Absorption (Physiologic effect)Vitamin B 6 (Chemical/Ingredient)Vitamin D (Chemical structure)
- Identifiers
- Product ID 10542-009_e4c39ddd-ac1c-48f2-8251-6b6fe4f570a9SPL ID e4c39ddd-ac1c-48f2-8251-6b6fe4f570a9SPL set ID 46fc3acf-1e6d-4830-ae9a-abd9c1132fcaUNII PQ6CK8PD0R, 1C6V77QF41, LU4B53JYVE, 8K0I04919X, TLM2976OFR, 25X51I8RD4, 68Y4CF58BV, 935E97BOY8, 8406EY2OQA, 6SO6U10H04, 568ET80C3D, K72I3DEX9B, 0CH9049VISUPC 0105420090904
- Pharmacologic class
- Copper Absorption Inhibitor; Vitamin B6 Analog; Vitamin C; Vitamin D
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
N410542000902followed by a unit qualifier and the quantityPackage 10542-0009-02. 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)
INDICATIONS AND USAGE Dialyvite Supreme D is a prescription folic acid supplement with additional nutrients indicated for use in improving the nutritional status of renal dialysis patients.
Excerpt only. Read the full label for complete information.