nicotine (nicotine polacrilex) NDC 11822-0170

NDC codes

FDA NDC Directory

Product NDC (as listed)11822-0170Labeler and product segments. Claims need a package NDC.

Product NDC at billing width11822-0170Add 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 NDC	11-digit (billing)	Package	Copy
11822-0170-1	11822017001	110 BLISTER PACK in 1 CARTON (11822-0170-1) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Jul 20, 2016
11822-0170-2	11822017002	170 BLISTER PACK in 1 CARTON (11822-0170-2) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Jul 20, 2016

How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 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
Generic name (nonproprietary): nicotine polacrilex
Active ingredients: Nicotine — 4 mg/1
Dosage form: Gum, Chewing
Route: Oral
Labeler: Rite Aid Corporation
Product type: Over-the-counter drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 076789
Marketing start: Jul 20, 2016
Marketing end: Nov 1, 2026
Other FDA classes: Nicotine (Chemical structure)
Identifiers: Product ID 11822-0170_bff73167-7796-43d7-97d2-bdda4a170801SPL ID bff73167-7796-43d7-97d2-bdda4a170801SPL set ID 1c49ddd3-0f2c-4310-acf1-edd42e3aafc5RxCUI 311975UNII 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. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N411822017001 followed by a unit qualifier and the quantity

Package 11822-0170-01. 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 Apr 28, 2026.

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.

Full label on DailyMed (opens in a new tab)

Other NDCs under ANDA 076789

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

FDA NDC Directory listings under ANDA 076789
Product	Strength	Form · route	Labeler	Product NDC
Good Sense Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	L. Perrigo Company	0113-0170
signature care nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Safeway	21130-522
Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Meijer Distribution Inc	41250-170
basic care nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Amazon.com Services LLC	72288-170
careone nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	American Sales Company	41520-891
Equate nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Wal-Mart Stores Inc	49035-170
Topcare Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Topco Associates LLC	36800-170
foster and thrive nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Strategic Sourcing Services LLC	70677-1167
kirkland signature quit 4nicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Costco Wholesale Company	63981-170
up and up uncoated original nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Target Corporation	82442-170
members mark nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Sam's West Inc	68196-170
berkley and jensen nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	BJWC	68391-170
nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Publix Super Markets Inc	56062-812
nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	H E B	37808-849