What is NDC 21130-890?

21130-890 is the product NDC for signature care childrens 12 hour cough relief, Dextromethorphan hydrobromide 30 mg/5mL suspension, listed with the FDA by Safeway. It has 1 package NDC, shown above in 10- and 11-digit form.

What drug is associated with this NDC?

signature care childrens 12 hour cough relief (Dextromethorphan polistirex).

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 signature care childrens 12 hour cough relief?

None: this is the only finished product listed under this name.

Is there a related HCPCS / J-code?

Not in Med-Code's curated HCPCS directory.

NDC 21130-890

NDC codes

FDA NDC Directory

Product NDC (as listed)21130-890Labeler and product segments. Claims need a package NDC.

Product NDC at billing width21130-0890Add 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
21130-890-21	21130089021	1 BOTTLE in 1 CARTON (21130-890-21) / 89 mL in 1 BOTTLEMarketed from May 27, 2022

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): signature care childrens 12 hour cough relief
Generic name (nonproprietary): dextromethorphan polistirex
Active ingredients: Dextromethorphan hydrobromide — 30 mg/5mL
Dosage form: Suspension
Route: Oral
Labeler: SafewayNDC labeler code 21130
Product type: Over-the-counter drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 091135
Marketing start: May 27, 2022
Listing expires: Dec 31, 2026
Other FDA classes: Sigma-1 Receptor Agonists (Mechanism)Uncompetitive NMDA Receptor Antagonists (Mechanism)
Identifiers: Product ID 21130-890_11838dd7-aea8-45f5-a25a-374b2e8858f6SPL ID 11838dd7-aea8-45f5-a25a-374b2e8858f6SPL set ID 62d71572-d157-484a-8676-7ce6da413ee8RxCUI 1373045UNII 9D2RTI9KYH
Pharmacologic class: Sigma-1 Agonist; Uncompetitive N-methyl-D-aspartate 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

N421130089021 followed by a unit qualifier and the quantity

Package 21130-0890-21. 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 Jun 1, 2022.

Indications (excerpt from the label)

Uses temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants • the impulse to cough to help you get to sleep

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

About NDC 21130-890

What is NDC 21130-890?: 21130-890 is the product NDC for signature care childrens 12 hour cough relief, Dextromethorphan hydrobromide 30 mg/5mL suspension, listed with the FDA by Safeway. It has 1 package NDC, shown above in 10- and 11-digit form.
What drug is associated with this NDC?: signature care childrens 12 hour cough relief (Dextromethorphan polistirex).
What is the active ingredient?: Dextromethorphan hydrobromide.
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 signature care childrens 12 hour cough relief?: None: this is the only finished product listed under this name.
Is there a related HCPCS / J-code?: Not in Med-Code's curated HCPCS directory. See Billing references above.

Other NDCs under ANDA 091135

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

FDA NDC Directory listings under ANDA 091135
Product	Strength	Form · route	Labeler	Product NDC
12 Hr Relief Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	CVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED	51316-263
12 hr relief cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	CVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED	51316-943
basic care childrens cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Amazon.com Services LLC	72288-899
basic care childrens cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Amazon.com Services LLC	72288-958
basic care cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Amazon.com Services LLC	72288-384
basic care cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	Amazon.com Services LLC	72288-494
CareOne Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	American Sales Company	41520-384
CareOne Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	American Sales Company	41520-958
Childrens 12 Hr Cough Reliefdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	CVS WOONSOCKET PRESCRIPTION CENTER, INCORPORATED	51316-429
childrens cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Walgreen Company	0363-0899
Childrens Robitussin 12 Hour Cough Reliefdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	Haleon US Holdings LLC	0031-8725
Childrens Robitussin 12 Hour Cough Reliefdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	Haleon US Holdings LLC	0031-8726
Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Walgreen Company	0363-0384
Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	Walgreen Company	0363-0494
cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Major Pharmaceuticals	0904-6312
cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	ATLANTIC BIOLOGICALS CORP.	17856-6312
Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Safeway	21130-538
Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	Kroger Company	30142-384
cough dmdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	Suspension, Extended releaseOral	Kroger Company	30142-494
Cough DMdextromethorphan polistirex	Dextromethorphan hydrobromide 30 mg/5mL	SuspensionOral	H E B	37808-384

Showing 20 of 40.

signature care childrens 12 hour cough relief (Dextromethorphan polistirex) NDC 21130-890