Dolishale NDC 50742-659

NDC codes

FDA NDC Directory

Product NDC (as listed)50742-659Labeler and product segments. Claims need a package NDC.

Product NDC at billing width50742-0659Add 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
50742-659-28	50742065928	1 BLISTER PACK in 1 CARTON (50742-659-28) / 28 TABLET in 1 BLISTER PACKMarketed from Jan 3, 2021
50742-659-68	50742065968	6 BLISTER PACK in 1 CARTON (50742-659-68) / 28 TABLET in 1 BLISTER PACKMarketed from Jan 3, 2021
50742-659-84	50742065984	3 BLISTER PACK in 1 CARTON (50742-659-84) / 28 TABLET in 1 BLISTER PACKMarketed from Jan 3, 2021

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): Dolishale
Generic name (nonproprietary): levonorgestrel and ethinyl estradiol
Active ingredients: Levonorgestrel — 90 ug/1Ethinyl estradiol — 20 ug/1
Dosage form: Tablet
Route: Oral
Labeler: Ingenus Pharmaceuticals, LLC
Product type: Prescription drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 091692
Marketing start: Jan 3, 2021
Listing expires: Dec 31, 2026
Other FDA classes: Estrogen Receptor Agonists (Mechanism)Inhibit Ovum Fertilization (Physiologic effect)Progesterone Congeners (Chemical structure)Progesterone Congeners (Chemical structure)
Identifiers: Product ID 50742-659_514dd27c-d315-4775-91d2-a58ac2293edcSPL ID 514dd27c-d315-4775-91d2-a58ac2293edcSPL set ID 036a15be-8c2e-4f65-b5dc-f333e2994d4aRxCUI 722152, 751553, 2472307UNII 5W7SIA7YZW, 423D2T571U
Pharmacologic class: Estrogen; Progestin; Progestin-containing Intrauterine System

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

N450742065928 followed by a unit qualifier and the quantity

Package 50742-0659-28. 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

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