Theophylline (Anhydrous) NDC 82804-942

NDC codes

FDA NDC Directory

Product NDC (as listed)82804-942Labeler and product segments. Claims need a package NDC.

Product NDC at billing width82804-0942Add 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
82804-942-00	82804094200	100 TABLET, EXTENDED RELEASE in 1 BOTTLE (82804-942-00)Marketed from Sep 17, 2026
82804-942-30	82804094230	30 TABLET, EXTENDED RELEASE in 1 BOTTLE (82804-942-30)Marketed from Sep 17, 2026
82804-942-60	82804094260	60 TABLET, EXTENDED RELEASE in 1 BOTTLE (82804-942-60)Marketed from Sep 17, 2026
82804-942-72	82804094272	120 TABLET, EXTENDED RELEASE in 1 BOTTLE (82804-942-72)Marketed from Sep 17, 2026
82804-942-90	82804094290	90 TABLET, EXTENDED RELEASE in 1 BOTTLE (82804-942-90)Marketed from Sep 17, 2026

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): Theophylline (Anhydrous)Suffix: (Anhydrous)
Generic name (nonproprietary): theophylline anhydrous
Active ingredients: Theophylline anhydrous — 600 mg/1
Dosage form: Tablet, Extended release
Route: Oral
Labeler: Proficient Rx LP
Product type: Prescription drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 040560
Marketing start: Nov 25, 2025
Listing expires: Dec 31, 2027
Other FDA classes: Xanthines (Chemical structure)
Identifiers: Product ID 82804-942_882657ae-e15b-4c86-a571-b55460bd4726SPL ID 882657ae-e15b-4c86-a571-b55460bd4726
Pharmacologic class: Methylxanthine

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

N482804094200 followed by a unit qualifier and the quantity

Package 82804-0942-00. 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

The FDA listing for this product does not reference a label (SPL) set.

Other NDCs under ANDA 040560

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

FDA NDC Directory listings under ANDA 040560
Product	Strength	Form · route	Labeler	Product NDC
Theophylline (Anhydrous)theophylline anhydrous	Theophylline anhydrous 400 mg/1	Tablet, Extended releaseOral	Westminster Pharmaceuticals, LLC	69367-414
Theophylline (Anhydrous)theophylline anhydrous	Theophylline anhydrous 600 mg/1	Tablet, Extended releaseOral	Westminster Pharmaceuticals, LLC	69367-415
Theophylline (Anhydrous)theophylline	Theophylline anhydrous 400 mg/1	Tablet, Extended releaseOral	Golden State Medical Supply, Inc.	51407-318
Theophylline (Anhydrous)theophylline	Theophylline anhydrous 600 mg/1	Tablet, Extended releaseOral	Golden State Medical Supply, Inc.	51407-319
Theophylline (Anhydrous)theophylline anhydrous	Theophylline anhydrous 400 mg/1	Tablet, Extended releaseOral	Proficient Rx LP	82804-941

Theophylline (Anhydrous) (theophylline anhydrous) NDC 82804-942