Dialyvite Supreme D Tablet, Coated
NDC Package 10542-009-09
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
Clinical Specifications
- .ALPHA.-TOCOPHEROL SUCCINATE, D- 30 [iU]/1
- ASCORBIC ACID 100 mg/1
- BIOTIN 300 ug/1
- CALCIUM PANTOTHENATE 10 mg/1
- CHOLECALCIFEROL 2000 [iU]/1
- COBALAMIN 1 mg/1
- FOLIC ACID 3 mg/1
- NIACINAMIDE 20 mg/1
- PYRIDOXINE HYDROCHLORIDE 25 mg/1
- RIBOFLAVIN 1.7 mg/1
- SELENOCYSTEINE 70 ug/1
- THIAMINE MONONITRATE 1.5 mg/1
- ZINC CITRATE 15 mg/1
- Analogs/Derivatives - [Chemical/Ingredient]
- Ascorbic Acid - [CS]
- Copper Absorption Inhibitor - [EPC] (Established Pharmacologic Class)
- Decreased Copper Ion Absorption - [PE] (Physiologic Effect)
- Vitamin B 6 - [Chemical/Ingredient]
- Vitamin B6 Analog - [EPC] (Established Pharmacologic Class)
- Vitamin C - [EPC] (Established Pharmacologic Class)
- Vitamin D - [CS]
- Vitamin D - [EPC] (Established Pharmacologic Class)
Regulatory & Marketing
Hierarchy Structure
- 10542 - Hillestad Pharmaceuticals Usa
- 10542-009 - Dialyvite Supreme D
- 10542-009-09 - 90 TABLET, COATED in 1 BOTTLE, PLASTIC
- 10542-009 - Dialyvite Supreme D
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.
* 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 10542-009-09 identifies a specific commercial package of 90 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: 10542000909. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 90 total billable units per package. 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:
Note: The zero is added to the Product segment to maintain the 5-4-2 structure.
