NDC Compounded Drug 72196-0216-1 Sodium Chloride; Magnesium Sulfate Heptahydrate; Potassium Chloride; Sodium Bicarbonate; Calcium Chloride

Solution Intracoronary

Compounded Product Information
NDC Crossover Products Matching Memorial Hermann Formula
Frequently Asked Questions

Compounded Drug Product Information

NDC Product Code	72196-0216
NDC Package Code	72196-0216-1
11-Digit NDC Billing Format NDC Format for Billing For insurance billing purposes the Centers for Medicare & Medicaid Services (CMS) created an 11 digit NDC derivative identifier. If the NDC Package code is less than 11 digits the code must be padded with leading zeros. The leading zeros must be added to the appropriate segment to create a 5-4-2 configuration.	72196021601
Package Description	1018 mL in 1 BAG
Product Type What kind of product is this? Indicates the type of product, such as Human Prescription Drug or Human Over the Counter Drug. This data element matches the “Document Type” field of the Structured Product Listing.	Human Compounded Drug
Proprietary Name What is the Proprietary Name? The proprietary name also known as the trade name is the name of the product chosen by the medication labeler for marketing purposes.	Memorial Hermann Formula
Non-Proprietary Name What is the Non-Proprietary Name? The non-proprietary name is sometimes called the generic name. The generic name usually includes the active ingredient(s) of the product.	Memorial Hermann Formula
Substance Name What is the Substance Name? An active ingredient is the substance responsible for the medicinal effects of a product specified by the substance's molecular structure or if the molecular structure is not known, defined by an unambiguous definition that identifies the substance. Each active ingredient name is the preferred term of the UNII code submitted.	Sodium Chloride; Magnesium Sulfate Heptahydrate; Potassium Chloride; Sodium Bicarbonate; Calcium Chloride
Dosage Form	Solution - A clear, homogeneous liquid1 dosage form that contains one or more chemical substances dissolved in a solvent or mixture of mutually miscible solvents.
Route Name	Intracoronary - Administration within the coronary arteries.
Marketing Category	OUTSOURCING FACILITY COMPOUNDED HUMAN DRUG PRODUCT (EXEMPT FROM APPROVAL REQUIREMENTS)
Labeler Code	72196
Labeler Name What is the Labeler Name? Name of Company corresponding to the labeler code segment of the Product NDC.	Central Admixture Pharmacy Services, Inc.
Substance Name	Sodium Chloride; Magnesium Sulfate Heptahydrate; Potassium Chloride; Sodium Bicarbonate; Calcium Chloride
Active Ingredients Information	110 meq/1018 mL; 32.074 meq/1018 mL; 40 meq/1018 mL; 420 mg/1018 mL; 3.808 meq/1018 mL
Reporting Period	2021-2

NDC Crossover Products Matching Sodium Chloride; Magnesium Sulfate Heptahydrate; Potassium Chloride; Sodium Bicarbonate; Calcium Chloride

NDC crossover of Memorial Hermann Formula with NDC 72196-0216 a human compounded drug with other similar products matching the same substance name (Sodium Chloride; Magnesium Sulfate Heptahydrate; Potassium Chloride; Sodium Bicarbonate; Calcium Chloride) and the same administration route (intracoronary) or dosage form (solution).

NDC	Proprietary Name	Non-Proprietary Name	Package Desc	Dosage Form	Route Name	Company Name
71285-0203-1	Modified St. Thomas Low K (62 Meq) High Sodium Bicarbonate 1000 Ml Bag	Modified St. Thomas Low K (62 Meq) High Sodium Bicarbonate 1000 Ml Bag	1052.8 mL in 1 BAG	Solution	Intracoronary	Central Admixture Pharmacy Services, Inc.
71285-0204-1	Modified St. Thomas High K (106 Meq) High Sodium Bicarbonate 1000 Ml Bag	Modified St. Thomas High K (106 Meq) High Sodium Bicarbonate 1000 Ml Bag	1000 mL in 1 BAG	Solution	Intracoronary	Central Admixture Pharmacy Services, Inc.
71285-0209-1	Modified St. Thomas Formula High K (122 Meq) 1000 Ml Bag	Modified St. Thomas Formula High K (122 Meq) 1000 Ml Bag	1000 mL in 1 BAG	Solution	Intracoronary	Central Admixture Pharmacy Services, Inc.
71285-0210-1	Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag	Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag	1000 mL in 1 BAG	Solution	Intracoronary	Central Admixture Pharmacy Services, Inc.

Frequently Asked Questions

What is the NDC number assigned to Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag?

Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag was assigned by its manufacturer with NDC product code 72196-0216. This product is a drug classified as a human compounded drug. Compounded drugs are medications created by combining or altering existing drugs to meet the specific needs of certain patients. The NDC directory only includes information about compounded drugs from facilities that choose to assign NDC numbers to their products.

Which are the NDC package codes for Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag?

The NDC package code 72196-0216-1 was assigned to a 1018 mL in 1 BAG of sodium chloride; magnesium sulfate heptahydrate; potassium chloride; sodium bicarbonate; calcium chloride administered intracoronary via solution.

Who manufactures this product?

Modified St. Thomas Formula Low K (70 Meq) 1000 Ml Bag is manufactured by an outsourced facility and labeled by Central Admixture Pharmacy Services, Inc.. All compounded drugs included in the NDC directory are classified as "Outsourcing Facility Compounded Human Drug Product (Exempt from Approval Requirements)". Outsourcing facilities are a type of drug compounding facility regulated under Section 503B of the FD&C Act could be eligible for exemptions from drug registration if they meet all the conditions specified under Section 503B.

Which are the NDC crossover matchings for this product?

We found 4 matching products that have the same substance, dosage form and administration route. The matching products are manufactured by Central Admixture Pharmacy Services, Inc. with NDC product codes 71285-0203-1, 71285-0204-1, 71285-0209-1 and 71285-0210-1.

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