Floriva NDC 52796-173

NDC codes

FDA NDC Directory

Product NDC (as listed)52796-173Labeler and product segments. Claims need a package NDC.

Product NDC at billing width52796-0173Add 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
52796-173-12	52796017312	12 BLISTER PACK in 1 CARTON (52796-173-12) / 1 TABLET, CHEWABLE in 1 BLISTER PACKMarketed from Sep 10, 2015
52796-173-90	52796017390	90 TABLET, CHEWABLE in 1 BOTTLE (52796-173-90)Marketed from Sep 10, 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): Floriva
Generic name (nonproprietary): vitamin a acetate, .beta.-carotene, ascorbic acid, cholecalciferol, .alpha.-tocopherol, thiamine, riboflavin, niacinamide, pyridoxine, levomefolate glucosamine, folic acid, cyanocobalamin, biotin, zinc gluconate, cupric oxide, and sodium fluoride
Active ingredients: Vitamin a acetate — 1000 [iU]/1Beta carotene — 1000 [iU]/1Ascorbic acid — 75 mg/1Cholecalciferol — 600 [iU]/1.alpha.-tocopherol — 20 [iU]/1Thiamine — 1.3 mg/1Riboflavin — 1.5 mg/1Niacinamide — 15 mg/1Pyridoxine — 1.8 mg/1Levomefolate glucosamine — 162 ug/1Folic acid — 100 ug/1Cyanocobalamin — 6 ug/1Biotin — 40 ug/1Zinc gluconate — 5 mg/1Cupric oxide — 1 mg/1Sodium fluoride — .25 mg/1
Dosage form: Tablet, Chewable
Route: Oral
Labeler: BonGeo Pharmaceuticals, Inc.
Product type: Prescription drug
Marketing category: Unapproved drug (other)
Marketing start: Sep 10, 2015
Listing expires: Dec 31, 2026
Other FDA classes: Analogs/Derivatives (Chemical/Ingredient)Ascorbic Acid (Chemical structure)Decreased Copper Ion Absorption (Physiologic effect)Vitamin A (Chemical structure)Vitamin B 12 (Chemical structure)Vitamin B 6 (Chemical/Ingredient)Vitamin D (Chemical structure)
Identifiers: Product ID 52796-173_fc2600e1-f961-4c00-9810-5612e8dfaaffSPL ID fc2600e1-f961-4c00-9810-5612e8dfaaffSPL set ID 3d5fbe3a-a95b-4688-a96e-b34e6e1e868aUNII 3LE3D9D6OY, 01YAE03M7J, PQ6CK8PD0R, 1C6V77QF41, H4N855PNZ1, X66NSO3N35, TLM2976OFR, 25X51I8RD4, KV2JZ1BI6Z, Q65PL71Q1A, 935E97BOY8, P6YC3EG204, 6SO6U10H04, U6WSN5SQ1Z, V1XJQ704R4, 8ZYQ1474W7
Pharmacologic class: Copper Absorption Inhibitor; Vitamin A; Vitamin B12; Vitamin B6 Analog; Vitamin C; Vitamin D

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

N452796017312 followed by a unit qualifier and the quantity

Package 52796-0173-12. 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 Feb 1, 2024.

Full label on DailyMed (opens in a new tab)