Walgreens Liquid
NDC Package 0363-7470-04

View Billable Units, 11-Digit Conversion Format, and RxNorm mappings
Table of Contents
    1. Package Information
    2. Frequently Asked Questions

Package Information

Walgreens (children cough and chest congestion) liquids is ▪do not take more than 6 doses in any 24-hour period▪measure only with dosing cup provided▪keep dosing cup with product▪mL = milliliter AgeDosechildren under 4 yearsdo not usechildren 4 to under 6 years5 mL every 4 hourschildren 6 to under 12 years10 mL every 4 hoursadults and children 12 years and older20 mL every 4 hours. This formulation utilizes a liquid delivery system. Marketed by Walgreens, this product is identified by NDC 0363-7470 and is authorized under FDA application M012.

Identification & Billing

NDC Package Code
0363-7470-04
Package Description
1 BOTTLE in 1 CARTON / 118 mL in 1 BOTTLE
Product Code
0363-7470
11-Digit Billing Format
00363747004
RxNorm Crosswalk
  • RxCUI: 1790650 - dextromethorphan HBr 10 MG / guaiFENesin 100 MG in 10 mL Oral Solution
  • RxCUI: 1790650 - dextromethorphan hydrobromide 1 MG/ML / guaifenesin 10 MG/ML Oral Solution
  • RxCUI: 1790650 - dextromethorphan HBr 10 MG / guaifenesin 100 MG per 10 ML Oral Solution
  • RxCUI: 1790650 - dextromethorphan HBr 20 MG / guaifenesin 200 MG per 20 ML Oral Solution
  • RxCUI: 1790650 - dextromethorphan HBr 5 MG / guaifenesin 50 MG per 5 ML Oral Solution

Clinical Specifications

Proprietary Name
Walgreens Grape Flavor
Non-Proprietary Name
Children Cough And Chest Congestion
Substance Name
Dextromethorphan Hydrobromide; Guaifenesin
Dosage Form
Liquid - A dosage form consisting of a pure chemical in its liquid1 state. This dosage form term should not be applied to solutions.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
▪do not take more than 6 doses in any 24-hour period▪measure only with dosing cup provided▪keep dosing cup with product▪mL = milliliter AgeDosechildren under 4 yearsdo not usechildren 4 to under 6 years5 mL every 4 hourschildren 6 to under 12 years10 mL every 4 hoursadults and children 12 years and older20 mL every 4 hours

Regulatory & Marketing

Labeler Name
Walgreens
Product Type
Human Otc Drug
FDA Application #
M012
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
05-15-2019
Listing Expiration
12-31-2026
Exclude Flag
N
Sample Package
No

Hierarchy Structure

Code Lineage

The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

* Please review the full disclaimer at the bottom of this page.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 0363-7470-04 identifies a specific commercial package of 1 bottle in 1 carton / 118 ml in 1 bottle of Walgreens Grape Flavor, a human over the counter drug labeled by Walgreens. This liquid is formulated for oral use and contains dextromethorphan hydrobromide; guaifenesin as the active substance.

Is this product currently listed with the FDA?

Yes, this product is active and verified within the NDC Directory. It was introduced to the market by Walgreens on May 15, 2019. The current certification is valid through December 31, 2026.

How is this Walgreens product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 00363747004. The table below illustrates the segment conversion from the 10-digit labeler code to the 11-digit provider format.

11-Digit Code Conversion

Billing payers usually require a 5-4-2 segment configuration. Below is the conversion from the 10-digit package format to the 11-digit billing format:

10-Digit Format (4-4-2)
0363-7470-04
11-Digit CMS (5-4-2)
00363-7470-04

Note: The zero is added to the Labeler segment to maintain the 5-4-2 structure.