Active substance: Ibuprofen, diphenhydramine HCl
Ibuprofen, diphenhydramine HCl (Ibuprofen, diphenhydramine HCl) NDC 11822-0789 converts to 11822-0789-04 for billing. It is dispensed by a pharmacy and billed directly on the NDC — no HCPCS J-code is required.
| Formulation / role | Package NDC | Product NDC | 11-digit HIPAA | Packaging detail | Copy |
|---|---|---|---|---|---|
| 200 mg/1, 25 mg/1 | 11822-0789-4 | 11822-0789 | 11822-0789-04 | 1 BOTTLE in 1 CARTON (11822-0789-4) / 40 CAPSULE, LIQUID FILLED in 1 BOTTLE | |
| 200 mg/1, 25 mg/1 | 11673-225-15 | 11673-225 | 11673-0225-15 | 1 BOTTLE in 1 CARTON (11673-225-15) / 40 CAPSULE, LIQUID FILLED in 1 BOTTLE | |
| 200 mg/1, 25 mg/1 | 69452-205-04 | 69452-205 | 69452-0205-04 | 1 BLISTER PACK in 1 CARTON (69452-205-04) / 6 CAPSULE, LIQUID FILLED in 1 BLISTER PACK | |
| 200 mg/1, 25 mg/1 | 69452-205-11 | 69452-205 | 69452-0205-11 | 20 CAPSULE, LIQUID FILLED in 1 BOTTLE (69452-205-11) | |
| 200 mg/1, 25 mg/1 | 69452-205-15 | 69452-205 | 69452-0205-15 | 40 CAPSULE, LIQUID FILLED in 1 BOTTLE (69452-205-15) | |
| 200 mg/1, 25 mg/1 | 69452-205-20 | 69452-205 | 69452-0205-20 | 100 CAPSULE, LIQUID FILLED in 1 BOTTLE (69452-205-20) | |
| 200 mg/1, 25 mg/1 | 69452-205-78 | 69452-205 | 69452-0205-78 | 80 CAPSULE, LIQUID FILLED in 1 BOTTLE (69452-205-78) |
Taken from the manufacturer's FDA Structured Product Labeling submission. This is the label as filed, not a summary.