Antacid Suspension
NDC Package 21130-508-05

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

Package Information

Antacid (aluminum hydroxide, magnesium hydroxide and simethicone) suspension is a medication used to treat symptoms caused by too much stomach acid such as heartburn, upset stomach, or indigestion. This formulation utilizes a suspension delivery system. Marketed by Safeway, this product is identified by NDC 21130-508 and is authorized under FDA application part332.

Identification & Billing

NDC Package Code
21130-508-05
Package Description
177 mL in 1 BOTTLE
Product Code
21130-508
11-Digit Billing Format
21130050805
RxNorm Crosswalk
  • RxCUI: 237870 - aluminum hydroxide 400 MG / magnesium hydroxide 400 MG / simethicone 40 MG in 5 mL Oral Suspension
  • RxCUI: 237870 - aluminum hydroxide 80 MG/ML / magnesium hydroxide 80 MG/ML / simethicone 8 MG/ML Oral Suspension
  • RxCUI: 237870 - aluminum hydroxide 2400 MG / magnesium hydroxide 2400 MG / dimethicone 240 MG per 30 ML Oral Suspension
  • RxCUI: 237870 - aluminum hydroxide 400 MG / magnesium hydroxide 400 MG / simethicone 40 MG per 5 ML Oral Suspension
  • RxCUI: 237870 - aluminum hydroxide 800 MG / magnesium hydroxide 800 MG / dimethicone 80 MG per 10 ML Oral Suspension

Clinical Specifications

Proprietary Name
Antacid
Non-Proprietary Name
Aluminum Hydroxide, Magnesium Hydroxide And Simethicone
Substance Name
Aluminum Hydroxide; Dimethicone; Magnesium Hydroxide
Dosage Form
Suspension - A liquid1 dosage form that contains solid particles dispersed in a liquid vehicle.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
This medication is used to treat symptoms caused by too much stomach acid such as heartburn, upset stomach, or indigestion. It is an antacid that works by lowering the amount of acid in the stomach. Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar names may contain different ingredients meant for different purposes. Taking the wrong product could harm you.

Regulatory & Marketing

Labeler Name
Safeway
Product Type
Human Otc Drug
FDA Application #
part332
Marketing Category
OTC MONOGRAPH FINAL - A product marketed pursuant to a final Over-the-Counter (OTC) Drug Monograph.
Start Marketing Date
12-12-2015
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 21130-508-05 identifies a specific commercial package of 177 ml in 1 bottle of Antacid, a human over the counter drug labeled by Safeway. This suspension is formulated for oral use and contains aluminum hydroxide; dimethicone; magnesium hydroxide 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 Safeway on December 12, 2015. The current certification is valid through December 31, 2026.

What are the primary indications for this medication?

This medication is used to treat symptoms caused by too much stomach acid such as heartburn, upset stomach, or indigestion. It is an antacid that works by lowering the amount of acid in the stomach. Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar names may contain different ingredients meant for different purposes. Taking the wrong product could harm you.

How is this Safeway product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 21130050805. 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)
21130-508-05
11-Digit CMS (5-4-2)
21130-0508-05

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