Over-the-counter drug · OTC MONOGRAPH DRUG
Pain Relief PM NDC 21130-095
acetaminophen and diphenhydramine hydrochloride · Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 · Tablet, Coated · Oral · Safeway
NDC codes
FDA NDC DirectoryProduct NDC (as listed)21130-095Labeler and product segments. Claims need a package NDC.
Product NDC at billing width21130-0095Add the package segment from the table below.
| Package NDC | 11-digit (billing) | Package | Copy |
|---|---|---|---|
| 21130-095-01 | 2113000950121130009501 | 1 BOTTLE, PLASTIC in 1 CARTON (21130-095-01) / 24 TABLET, COATED in 1 BOTTLE, PLASTICMarketed from Dec 23, 2015 | |
| 21130-095-03 | 2113000950321130009503 | 1 BOTTLE, PLASTIC in 1 CARTON (21130-095-03) / 100 TABLET, COATED in 1 BOTTLE, PLASTICMarketed from Dec 23, 2015 | |
| 21130-095-14 | 2113000951421130009514 | 200 TABLET, COATED in 1 BOTTLE, PLASTIC (21130-095-14)Marketed from Dec 23, 2015 |
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)
- Pain Relief PM
- Generic name (nonproprietary)
- acetaminophen and diphenhydramine hydrochloride
- Active ingredients
- Acetaminophen — 500 mg/1Diphenhydramine hydrochloride — 25 mg/1
- Dosage form
- Tablet, Coated
- Route
- Oral
- Labeler
- SafewayNDC labeler code 21130
- Product type
- Over-the-counter drug
- Marketing category
- OTC monograph drugApplication M 013
- Marketing start
- Listing expires
- Other FDA classes
- Histamine H1 Receptor Antagonists (Mechanism)
- Identifiers
- Product ID 21130-095_39f81b58-dec5-deb5-e063-6394a90ad1f0SPL ID 39f81b58-dec5-deb5-e063-6394a90ad1f0SPL set ID f9597abc-3f01-4b94-8078-228e0b74677eRxCUI 1092189UNII 362O9ITL9D, TC2D6JAD40
- Pharmacologic class
- Histamine-1 Receptor Antagonist
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
N421130009501followed by a unit qualifier and the quantityPackage 21130-0095-01. 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 .
Indications (excerpt from the label)
Uses temporary relief of occasional headaches and minor aches and pains with accompanying sleeplessness
Excerpt only. Read the full label for complete information.
About NDC 21130-095
- What is NDC 21130-095?
- 21130-095 is the product NDC for Pain Relief PM, Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 tablet, coated, listed with the FDA by Safeway. It has 3 package NDCs, shown above in 10- and 11-digit form.
- What drug is associated with this NDC?
- Pain Relief PM (Acetaminophen and Diphenhydramine Hydrochloride).
- What is the active ingredient?
- Acetaminophen, Diphenhydramine hydrochloride.
- Who is the labeler?
- Safeway, NDC labeler code 21130. The labeler is the company responsible for the label; it may be the manufacturer, a repackager or a distributor.
- What other NDCs exist for Pain Relief PM?
- 14 other product NDCs are listed under this name. See all Pain Relief PM NDCs.
- Is there a related HCPCS / J-code?
- Not in Med-Code's curated HCPCS directory. See Billing references above.
Related NDCs: other Pain Relief PM products
Other finished products listed under the same name: strengths, forms and labelers.
| Product | Strength | Form · route | Labeler | Product NDC | Package NDCs (11-digit) |
|---|---|---|---|---|---|
| pain relief pmibuprofen and diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | Bionpharma Inc. | 69452-507 | 69452-0507-78 |
| Pain Relief PMacetaminophen and diphenhydramine hydrochloride | Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Tablet, CoatedOral | HYVEE INC | 42507-095 | 42507-0095-0342507-0095-17 |
| Pain Relief PMacetaminophen, diphenhydramine | Diphenhydramine hydrochloride 25 mg/1; Acetaminophen 500 mg/1 | TabletOral | Pioneer Life Sciences, LLC | 72090-032 | 72090-0032-01 |
| Pain Relief PMacetaminophen, diphenhydramine | Diphenhydramine hydrochloride 25 mg/1; Acetaminophen 500 mg/1 | TabletOral | NUVICARE LLC | 84324-005 | 84324-0005-01 |
| Pain Relief PMacetaminophen, diphenhydramine | Diphenhydramine hydrochloride 25 mg/1; Acetaminophen 500 mg/1 | TabletOral | Pioneer Life Sciences, LLC | 72090-006 | 72090-0006-25 |
| Pain Relief PMacetaminophen, diphenhydramine hcl | Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 | TabletOral | DOLGENCORP, INC. | 55910-834 | 55910-0834-0155910-0834-05 |
| Pain Relief PMacetaminophen and diphenhydramine hydrochloride | Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Tablet, CoatedOral | AMERIFOODS TRADING COMPANY | 61504-095 | 61504-0095-03 |
| Pain Relief PMacetaminophen, diphenhydramine hcl | Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Tablet, CoatedOral | Topco Associates, LLC | 36800-556 | 36800-0556-0936800-0556-10 |
| Pain Relief PMacetaminophen, diphenhydramine hcl | Acetaminophen 500 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Tablet, CoatedOral | Strategic Sourcing Services LLC | 70677-0081 | 70677-0081-01 |
| pain relief pmibuprofen, diphenhydramine hcl | Ibuprofen 200 mg/1; Diphenhydramine hydrochloride 25 mg/1 | Capsule, Liquid filledOral | Bionpharma Inc. | 69452-264 | 69452-0264-22 |
Other NDCs under M 013
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 |
|---|---|---|---|---|
| Acetaminophen | Acetaminophen 500 mg/1 | Tablet, CoatedOral | COSTCO WHOLESALE CORPORATION | 63981-019 |
| Extra Strength Pain Releifacetaminophen | Acetaminophen 500 mg/1 | Tablet, Film coatedOral | Strategic Sourcing Services, LLC | 70677-1242 |
| Aspirin 81 mgaspirin | Aspirin 81 mg/1 | Tablet, Delayed releaseOral | H E B | 37808-600 |
| TYLENOL Extra Strengthacetaminophen | Acetaminophen 500 mg/1 | Tablet, Film coatedOral | Morning Star OTC | 53209-1001 |
| Extra Strength Pain Relieveracetaminophen tablets 500 mg | Acetaminophen 500 mg/1 | TabletOral | WALGREENS | 0363-0669 |
| Pain Relieveracetaminophen capsules 500mg (minis-red opaque) | Acetaminophen 500 mg/1 | Capsule, Liquid filledOral | Walgreens | 0363-6684 |
| Mommys Bliss Childrens Pain and Feveracetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | Mom Enterprises, LLC. | 71444-793 |
| Childrens Pain and Feveracetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | CVS Pharmacy | 59779-126 |
| Good Neighbor Pharmacy childrens pain and feveracetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | Amerisource Bergen | 46122-211 |
| Acetaminophen | Acetaminophen 160 mg/5mL | LiquidOral | A-S Medication Solutions | 50090-6059 |
| Members Mark Acetaminophenacetaminophen | Acetaminophen 500 mg/1 | TabletOral | Sam's West Inc | 68196-606 |
| Mommys Bliss Infants Pain and Feveracetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | Mom Enterprises, LLC. | 71444-893 |
| Thompson Extra Strength Non-Aspirinacetaminophen | Acetaminophen 500 mg/1 | TabletOral | Thompson | 73408-174 |
| Aspirin 81 mg Low Doseaspirin | Aspirin 81 mg/1 | Tablet, Delayed releaseOral | CHAIN DRUG MARKETING ASSOCIATION, INC. | 83324-089 |
| Acetaminophen | Acetaminophen 500 mg/1 | TabletOral | ASCLEMED USA INC. | 87063-222 |
| Pain Relief Aspirin Low Doseaspirin | Aspirin 81 mg/1 | Tablet, Delayed releaseOral | Rite Aid Corporation | 11822-0600 |
| equate pain and fever childrensacetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | Wal-Mart Stores Inc | 49035-042 |
| Pain and Fever Childrensacetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | P & L Development, LLC | 49580-0282 |
| Dye Free Pain and Fever Childrensacetaminophen | Acetaminophen 160 mg/5mL | SuspensionOral | Walgreens | 0363-0285 |
| Pain Reliever Extra Strengthacetaminophen | Acetaminophen 500 mg/1 | Tablet, CoatedOral | Walgreen Company | 0363-0519 |
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