Rite Aid Antacid And Pain Relief Tablet, Effervescent
NDC Package 11822-4212-4

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

Rite Aid Antacid And Pain Relief (aspirin, citric acid, sodium bicarbonate) tablets is ■ do not exceed recommended dosage■ to avoid serious injury, completely dissolve tablets in 4 oz. This formulation utilizes a tablet, effervescent delivery system. Marketed by Rite Aid, this product is identified by NDC 11822-4212 and is authorized under FDA application M013.

Identification & Billing

NDC Package Code
11822-4212-4
Package Description
12 POUCH in 1 CARTON / 2 TABLET, EFFERVESCENT in 1 POUCH
Product Code
11822-4212
11-Digit Billing Format
11822421204
RxNorm Crosswalk
  • RxCUI: 1536675 - aspirin 325 MG / citric acid 1000 MG / sodium bicarbonate 1916 MG Effervescent Oral Tablet
  • RxCUI: 1536675 - ASA 325 MG / Citric Acid 1000 MG / NaHCO3 1916 MG Effervescent Oral Tablet

Clinical Specifications

Proprietary Name
Rite Aid Antacid And Pain Relief
Non-Proprietary Name
Aspirin, Citric Acid, Sodium Bicarbonate
Substance Name
Anhydrous Citric Acid; Aspirin; Sodium Bicarbonate
Dosage Form
Tablet, Effervescent - A solid dosage form containing mixtures of acids (e.g., citric acid, tartaric acid) and sodium bicarbonate, which release carbon dioxide when dissolved in water; it is intended to be dissolved or dispersed in water before administration.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
■ do not exceed recommended dosage■ to avoid serious injury, completely dissolve tablets in 4 oz. of water before takingadults and children 12 years and over (up to 60 years of age) - 2 tablets every 4 hours do not exceed 8 tablets in 24 hours60 years and over - 2 tablets every 4 hours do not exceed 4 tablets in 24 hoursChildren under 12 years - consult a doctor

Regulatory & Marketing

Labeler Name
Rite Aid
Product Type
Human Otc Drug
FDA Application #
M013
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
03-16-2020
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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (11822-4212). Click a package code to view its specific billing and regulatory data.

11822-4212-7
36 POUCH in 1 CARTON / 2 TABLET, EFFERVESCENT in 1 POUCH

* 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 11822-4212-4 identifies a specific commercial package of 12 pouch in 1 carton / 2 tablet, effervescent in 1 pouch of Rite Aid Antacid And Pain Relief, a human over the counter drug labeled by Rite Aid. This tablet, effervescent is formulated for oral use and contains anhydrous citric acid; aspirin; sodium bicarbonate 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 Rite Aid on March 16, 2020. The current certification is valid through December 31, 2026.

How is this Rite Aid product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 11822421204. 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 (5-4-1)
11822-4212-4
11-Digit CMS (5-4-2)
11822-4212-04

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