NDC Compounded Drug 73198-104-30 Glutathione; Ascorbic Acid; Zinc Sulfate

Injection, Solution Intramuscular; Intravenous

Table of Contents

    1. Compounded Product Information
    2. Frequently Asked Questions

Compounded Drug Product Information

NDC Product Code 73198-104
NDC Package Code 73198-104-30
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.		 73198010430
Package Description 30 mL in 1 VIAL, MULTI-DOSE
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.		 Tri-immune Boost
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.		 Glutathione 200mg/ascorbic Acid 200mg/zinc Sulfate 2.5mg/ml
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.		 Glutathione; Ascorbic Acid; Zinc Sulfate
Dosage Form Injection, Solution - A liquid preparation containing one or more drug substances dissolved in a suitable solvent or mixture of mutually miscible solvents that is suitable for injection.
Route Name Intramuscular; Intravenous -
Marketing Category OUTSOURCING FACILITY COMPOUNDED HUMAN DRUG PRODUCT (EXEMPT FROM APPROVAL REQUIREMENTS)
Labeler Code 73198
Labeler Name What is the Labeler Name?
Name of Company corresponding to the labeler code segment of the Product NDC.		 Olympia Pharmacy
Substance Name Glutathione; Ascorbic Acid; Zinc Sulfate
Active Ingredients Information 200 mg/1 mL; 200 mg/1 mL; 2.5 mg/1 mL
Reporting Period 2023-1

Frequently Asked Questions

What is the NDC number assigned to Tri-immune Boost?

Tri-immune Boost was assigned by its manufacturer with NDC product code 73198-104. 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 Tri-immune Boost?

The NDC package code 73198-104-30 was assigned to a 30 mL in 1 VIAL, MULTI-DOSE of glutathione; ascorbic acid; zinc sulfate administered intramuscular; intravenous via injection, solution.

Who manufactures this product?

Tri-immune Boost is manufactured by an outsourced facility and labeled by Olympia Pharmacy. 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.