Dialyvite Supreme D Tablet, Coated
NDC Package 10542-009-02

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

Package Information

Dialyvite Supreme D (ascorbic acid, cholecalciferol, alpha-tocopherol, thiamine, riboflavin, niacinamide, pyridoxine, folic acid, cobalamin, biotin, pantothenic acid, zinc, selenium) tablets is dialyvite Supreme D is a prescription folic acid supplement with additional nutrients indicated for use in improving the nutritional status of renal dialysis patients. This formulation utilizes a tablet, coated delivery system. Marketed by Hillestad Pharmaceuticals Usa, this product is identified by NDC 10542-009.

Identification & Billing

NDC Package Code
10542-009-02
Package Description
7 TABLET, COATED in 1 BOTTLE, PLASTIC
Product Code
10542-009
11-Digit Billing Format
10542000902

Clinical Specifications

Proprietary Name
Dialyvite Supreme D
Non-Proprietary Name
Ascorbic Acid, Cholecalciferol, Alpha-tocopherol, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid, Zinc, Selenium
Substance Name
.alpha.-tocopherol Succinate, D-; Ascorbic Acid; Biotin; Calcium Pantothenate; Cholecalciferol; Cobalamin; Folic Acid; Niacinamide; Pyridoxine Hydrochloride; Riboflavin; Selenocysteine; Thiamine Mononitrate; Zinc Citrate
Dosage Form
Tablet, Coated - A solid dosage form that contains medicinal substances with or without suitable diluents and is covered with a designated coating.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
Dialyvite Supreme D is a prescription folic acid supplement with additional nutrients indicated for use in improving the nutritional status of renal dialysis patients.

Regulatory & Marketing

Labeler Name
Hillestad Pharmaceuticals Usa
Product Type
Human Prescription Drug
Marketing Category
UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
Start Marketing Date
09-08-2010
End Marketing Date
10-31-2026
Exclude Flag
N
Sample Package
Yes

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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (10542-009). Click a package code to view its specific billing and regulatory data.

10542-009-09
90 TABLET, COATED in 1 BOTTLE, PLASTIC

* 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 10542-009-02 identifies a specific commercial package of 7 tablet, coated in 1 bottle, plastic of Dialyvite Supreme D, a human prescription drug labeled by Hillestad Pharmaceuticals Usa. This tablet, coated is formulated for oral use and contains .alpha.-tocopherol succinate, d-; ascorbic acid; biotin; calcium pantothenate; cholecalciferol; cobalamin; folic acid; niacinamide; pyridoxine hydrochloride; riboflavin; selenocysteine; thiamine mononitrate; zinc citrate 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 Hillestad Pharmaceuticals Usa on September 08, 2010.

How is this Hillestad Pharmaceuticals Usa product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 10542000902. 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 (5-3-2)
10542-009-02
11-Digit CMS (5-4-2)
10542-0009-02

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