Vitrexyl (folic acid) NDC 59088-164

NDC codes

FDA NDC Directory

Product NDC (as listed)59088-164Labeler and product segments. Claims need a package NDC.

Product NDC at billing width59088-0164Add 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
59088-164-54	59088016454	30 TABLET in 1 BOTTLE, PLASTIC (59088-164-54)Marketed from Aug 29, 2020

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): Vitrexyl
Generic name (nonproprietary): folic acid
Active ingredients: .alpha.-tocopherol acetate, Dl- — 30 mg/1Magnesium oxide — 200 mg/1Chromium nicotinate — 35 ug/1Pyridoxine hydrochloride — 20 mg/1Molybdenum — 45 ug/1Selenium — 55 ug/1Cholecalciferol — 20 ug/1Riboflavin — 3.4 mg/1Niacinamide — 20 mg/1Ascorbic acid — 120 mg/1Folic acid — 1000 ug/1Cyanocobalamin — 8 ug/1Calcium carbonate — 200 mg/1Vitamin a acetate — 1500 ug/1Thiamine mononitrate — 3 mg/1Zinc oxide — 25 mg/1Manganese sulfate — 2.3 mg/1
Dosage form: Tablet
Route: Oral
Labeler: PureTek Corporation
Product type: Prescription drug
Marketing category: Unapproved drug (other)
Marketing start: Aug 29, 2020
Listing expires: Dec 31, 2026
Other FDA classes: Analogs/Derivatives (Chemical/Ingredient)Ascorbic Acid (Chemical structure)Calcium (Chemical structure)Divalent (Chemical structure)Decreased Copper Ion Absorption (Physiologic effect)Increased Coagulation Factor Activity (Physiologic effect)Increased Large Intestinal Motility (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Inhibition Small Intestine Fluid/Electrolyte Absorption (Physiologic effect)Magnesium Ion Exchange Activity (Mechanism)Magnetic Resonance Contrast Activity (Mechanism)Osmotic Activity (Mechanism)Stimulation Large Intestine Fluid/Electrolyte Secretion (Physiologic effect)Vitamin A (Chemical structure)Vitamin B 12 (Chemical structure)Vitamin B 6 (Chemical/Ingredient)Vitamin D (Chemical structure)
Identifiers: Product ID 59088-164_f2048b24-433c-98ba-e053-2995a90a5e85SPL ID f2048b24-433c-98ba-e053-2995a90a5e85SPL set ID ae064a9e-daba-fa86-e053-2a95a90a16a7UNII WR1WPI7EW8, 3A3U0GI71G, A150AY412V, 68Y4CF58BV, 81AH48963U, H6241UJ22B, 1C6V77QF41, TLM2976OFR, 25X51I8RD4, PQ6CK8PD0R, 935E97BOY8, P6YC3EG204, H0G9379FGK, 3LE3D9D6OY, 8K0I04919X, SOI2LOH54Z, W00LYS4T26UPC 0359088164549
Pharmacologic class: Blood Coagulation Factor; Calculi Dissolution Agent; Copper Absorption Inhibitor; Osmotic Laxative; Paramagnetic Contrast Agent; 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

N459088016454 followed by a unit qualifier and the quantity

Package 59088-0164-54. 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 11, 2023.

Indications (excerpt from the label)

INDICATIONS: Vitrexyl™ is indicated to provide vitamin supplement to men and women. Folic acid is effective in the treatment of megaloblastic anemias due to a deficiency of folic acid (as may be seen in tropical or nontropical sprue) and in anemias of nutritional origin, pregnancy, infancy, or childhood.

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)