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  5. NDC Package Code: 0904-0049-20 Formula Em

NDC Package 0904-0049-20 Formula Em

Dextrose (glucose),Levulose (fructose),Phosphoric Acid Solution Oral - View Billable Units, 11-Digit Format, RxNorm

Table of Contents

    1. Package Information
    2. Frequently Asked Questions

Package Information

Find all the important details about this NDC Package code, including the 11-Digit NDC Billing number, billing units, wholesale price, RxNorm crosswalk, active ingredients, pharmacologic clasess, etc.

NDC Package Code:
0904-0049-20
Package Description:
1 BOTTLE in 1 CARTON / 118 mL in 1 BOTTLE
Product Code:
0904-0049
Proprietary Name:
Formula Em
Non-Proprietary Name:
Dextrose (glucose), Levulose (fructose), Phosphoric Acid
Substance Name:
Dextrose; Fructose; Phosphoric Acid
Usage Information:
•for maximum effectiveness, never dilute or drink fluids of any kind immediately before or after taking this product•adults and children 12 years of age and over: 15 mL to 30 mL•children 2 to under 12: 5 mL to 10 mL•repeat dose every 15 minutes or until distress subsides•do not take more than 5 doses in 1 hour without consulting a doctor•only use the dose cup provided
11-Digit NDC Billing Format:
00904004920
Billing Unit:
ML - Billing unit of "milliliter" is used when a product is measured by its liquid volume.
NDC to RxNorm Crosswalk:
  • RxCUI: 318146 - dextrose 1.87 GM / fructose 1.87 GM / phosphoric acid 21.5 MG in 5 mL Oral Solution
  • RxCUI: 318146 - fructose 374 MG/ML / glucose 374 MG/ML / phosphoric acid 4.3 MG/ML Oral Solution
  • RxCUI: 318146 - dextrose 1.87 GM / fructose 1.87 GM / phosphoric acid 21.5 MG per 5 ML Oral Solution
    • Product Type:
    Human Otc Drug
    Labeler Name:
    Major Pharmaceuticals
    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.
    Administration Route(s):
  • Oral - Administration to or by way of the mouth.
    • Active Ingredient(s):
  • DEXTROSE 1.87 g/5mL
  • FRUCTOSE 1.87 g/5mL
  • PHOSPHORIC ACID 21.5 mg/5mL
    • Sample Package:
    No
    Marketing Category:
    UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
    Start Marketing Date:
    04-15-1994
    Listing Expiration Date:
    12-31-2024
    Exclude Flag:
    N
    Code Structure:

    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 disclaimer below.

    Frequently Asked Questions

    What is NDC 0904-0049-20?

    The NDC Packaged Code 0904-0049-20 is assigned to a package of 1 bottle in 1 carton / 118 ml in 1 bottle of Formula Em, a human over the counter drug labeled by Major Pharmaceuticals. The product's dosage form is solution and is administered via oral form.

    Is NDC 0904-0049 included in the NDC Directory?

    Yes, Formula Em with product code 0904-0049 is active and included in the NDC Directory. The product was first marketed by Major Pharmaceuticals on April 15, 1994 and its listing in the NDC Directory is set to expire on December 31, 2024 if the product is not updated or renewed by the manufacturer.

    What is the NDC billing unit for package 0904-0049-20?

    The contents of this package are billed per "ml or milliliter", products billed per milliliter are usually products measured by liquid volume.

    What is the 11-digit format for NDC 0904-0049-20?

    The 11-digit format is 00904004920. The 11-digit billing format might be required by the Centers for Medicare & Medicaid Services (CMS) and other payers in billing claim forms.

    This package code is originally configured in a 4-4-2 segment 10-digit format and by adding a zero within the original NDC package code we can obtain the converted 11-digit format in a 5-4-2 segment configuration. The table below shows the 11-digit code conversion:

    10-Digit Format10-Digit Original Code11-Digit Format11-Digit Code
    4-4-20904-0049-205-4-200904-0049-20