Nicotine Polacrilex NDC 55301-504

NDC codes

FDA NDC Directory

Product NDC (as listed)55301-504Labeler and product segments. Claims need a package NDC.

Product NDC at billing width55301-0504Add 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
55301-504-44	55301050444	100 BLISTER PACK in 1 CARTON (55301-504-44) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Jan 1, 2014

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): Nicotine Polacrilex
Generic name (nonproprietary): nicotine polacrilex
Active ingredients: Nicotine — 4 mg/1
Dosage form: Gum, Chewing
Route: Buccal
Labeler: AAFES/Your Military Exchanges
Product type: Over-the-counter drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 079038
Marketing start: Jan 1, 2014
Listing expires: Dec 31, 2027
Other FDA classes: Nicotine (Chemical structure)
Identifiers: Product ID 55301-504_f9506509-28e9-490f-88db-7ca4823ca731SPL ID f9506509-28e9-490f-88db-7ca4823ca731SPL set ID 6d895db2-7423-42bc-ae78-e0b47189e2d2RxCUI 311975, 314119UNII 6M3C89ZY6R
Pharmacologic class: Cholinergic Nicotinic Agonist

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. Buccal products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N455301050444 followed by a unit qualifier and the quantity

Package 55301-0504-44. 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 Jan 16, 2026.

Indications (excerpt from the label)

Use reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

Other NDCs under ANDA 079038

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

FDA NDC Directory listings under ANDA 079038
Product	Strength	Form · route	Labeler	Product NDC
Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Lucy Goods, Inc.	72224-931
Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Walgreens	0363-9310
Nicotine Polacrilex coated fruitnicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingBuccal	CVS Pharmacy	69842-025
Nicotine Polacrilex Coated Fruitnicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingBuccal	Publix Supermarkets, Inc.	56062-504
Habitrol Nicotine Polacrilex Gum 4 mg Coated Fruitnicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Dr. Reddy's Laboratories Inc.	75907-300
Rugby Nicotine Polacrilex Gum, Coated Fruit Flavornicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingBuccal	Rugby Laboratories	0536-3387
Nicotine Polacrilex Coated Fruitnicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingBuccal	CARDINAL HEALTH 110, LLC. DBA LEADER 70000	70000-0342
Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	P & L Development, LLC	59726-913
Nicotinenicotine polacrilex	Nicotine 4 mg/1	Gum, ChewingOral	Dolgencorp, Inc. (DOLLAR GENERAL & REXALL)	55910-918