Over-the-counter drug · ANDA

Nicotine Polacrilex coated mint (nicotine polacrilex) NDC 69842-430

Nicotine 4 mg/1 · Gum, Chewing · Buccal · CVS Pharmacy

NDC codes

FDA NDC Directory
Product NDC (as listed)69842-430Labeler and product segments. Claims need a package NDC.
Product NDC at billing width69842-0430Add 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
69842-430-1669842043016160 BLISTER PACK in 1 CARTON (69842-430-16) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Jan 1, 2014
69842-430-2269842043022120 BLISTER PACK in 1 CARTON (69842-430-22) / 1 GUM, CHEWING in 1 BLISTER PACKMarketed from Jan 1, 2014
69842-430-796984204307910 BLISTER PACK in 1 CARTON (69842-430-79) / 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 coated mintSuffix: coated mint
Generic name (nonproprietary)
nicotine polacrilex
Active ingredients
Nicotine — 4 mg/1
Dosage form
Gum, Chewing
Route
Buccal
Product type
Over-the-counter drug
Marketing category
ANDA — Abbreviated New Drug Application (generic)Application ANDA 078697
Marketing start
Listing expires
Other FDA classes
Nicotine (Chemical structure)
Identifiers
Product ID 69842-430_e42098ad-5498-4210-9046-0c1987640246SPL ID e42098ad-5498-4210-9046-0c1987640246SPL set ID 84daeb67-5982-4b9e-b56a-4cc6a223a3f8RxCUI 311975, 314119UNII 6M3C89ZY6RUPC 0050428299210, 0050428398364
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

N469842043016 followed by a unit qualifier and the quantity

Package 69842-0430-16. 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)

Other NDCs under ANDA 078697

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

FDA NDC Directory listings under ANDA 078697
ProductStrengthForm · routeLabelerProduct NDC
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralQuitine LLC84720-933
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingBuccalAAFES/Your Military Exchanges55301-429
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-281
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-285
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralDolgencorp, Inc. (DOLLAR GENERAL & REXALL)55910-976
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalChain Drug Consortium, LLC68016-560
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralAmerisourceBergen (Good Neighbor Pharmacy) 4612246122-718
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralRising Pharma Holdings, Inc.57237-323
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralLucy Goods, Inc.72224-933
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalPublix Supermarkets, Inc.56062-429
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralWalgreens0363-9330
Nicotinenicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalRugby Laboratories0536-3113
Nicotine PolacrilexNicotine 4 mg/1Gum, ChewingOralDolgencorp, Inc. (DOLLAR GENERAL & REXALL)55910-796
Habitrol Nicotine Polacrilex Gum 4 mg Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingOralDr. Reddy's Laboratories Inc.75907-303
Nicotine Polacrilex Coated Mintnicotine polacrilexNicotine 4 mg/1Gum, ChewingBuccalCARDINAL HEALTH 110, LLC. DBA LEADER 7000070000-0343

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Nicotine Polacrilex coated mint NDC 69842-430 | Med-Code