NDC codes

FDA NDC Directory
Product NDC (as listed)55910-122Labeler and product segments. Claims need a package NDC.
Product NDC at billing width55910-0122Add 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 NDC11-digit (billing)PackageCopy
55910-122-58559100122585591001225840 BLISTER PACK in 1 CARTON (55910-122-58) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from May 19, 2023

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)
dg health nicotine
Generic name (nonproprietary)
nicotine polacrilex
Active ingredients
Nicotine — 4 mg/1
Dosage form
Gum, Chewing
Route
Oral
Labeler
Dolgencorp IncNDC labeler code 55910
Product type
Over-the-counter drug
Marketing category
ANDA — Abbreviated New Drug Application (generic)Application ANDA 076779
Marketing start
Listing expires
Other FDA classes
Nicotine (Chemical structure)
Identifiers
Product ID 55910-122_d45ee96a-05a0-4a35-8d76-fccacacf23a3SPL ID d45ee96a-05a0-4a35-8d76-fccacacf23a3SPL set ID 64b2982d-491e-42e7-b65e-7abf5530b935RxCUI 311975UNII 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. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N455910012258 followed by a unit qualifier and the quantity

Package 55910-0122-58. 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)

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)

About NDC 55910-122

What is NDC 55910-122?
55910-122 is the product NDC for dg health nicotine (nicotine polacrilex), Nicotine 4 mg/1 gum, chewing, listed with the FDA by Dolgencorp Inc. It has 1 package NDC, shown above in 10- and 11-digit form.
What drug is associated with this NDC?
dg health nicotine (Nicotine Polacrilex).
What is the active ingredient?
Nicotine.
Who is the labeler?
Dolgencorp Inc, NDC labeler code 55910. The labeler is the company responsible for the label; it may be the manufacturer, a repackager or a distributor.
What other NDCs exist for dg health nicotine?
1 other product NDC are listed under this name. See all dg health nicotine NDCs.
Is there a related HCPCS / J-code?
Not in Med-Code's curated HCPCS directory. See Billing references above.

Other finished products listed under the same name: strengths, forms and labelers.

Other dg health nicotine NDCs
ProductStrengthForm · routeLabelerProduct NDCPackage NDCs (11-digit)
Dg Health Nicotinenicotine polacrilexNicotine 4 mg/1LozengeOralDolgencorp Inc55910-66955910-0669-60

Other NDCs under ANDA 076779

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

FDA NDC Directory listings under ANDA 076779
ProductStrengthForm · routeLabelerProduct NDC
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralAmazon.com Services LLC72288-730
Foster and Thrive Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralStrategic Sourcing Services LLC70677-1171
Topcare Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralTopco Associates LLC36800-532
Equate nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralWal-Mart Stores Inc49035-532
quitine nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralQUITINE LLC84720-532
Good Sense Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralL. Perrigo Company0113-0532
Up and Up Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralTarget Corporation82442-532
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralH E B37808-658
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralRite Aid Corporation11822-0699
basic care nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralAmazon.com Services LLC72288-532
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralMeijer Distribution Inc41250-532
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingOralWalgreen Company0363-0919

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