4x Medicated Gum Cream
NDC Package 21130-621-19

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

Package Information

4x Medicated Gum Cream (benzocaine) cream is for the temporary relief of pain due to toothaches * to help protect against infection of minor oral irritation. This formulation utilizes a cream delivery system. Marketed by Albertsons, this product is identified by NDC 21130-621 and is authorized under FDA application M017.

Identification & Billing

NDC Package Code
21130-621-19
Package Description
9.4 g in 1 TUBE
Product Code
21130-621
11-Digit Billing Format
21130062119

Clinical Specifications

Proprietary Name
4x Medicated Gum Cream
Non-Proprietary Name
Benzocaine
Substance Name
Benzalkonium Chloride; Benzocaine; Menthol, Unspecified Form; Zinc Chloride
Dosage Form
Cream - An emulsion, semisolid3 dosage form, usually containing > 20% water and volatiles5 and/or < 50% hydrocarbons, waxes, or polyols as the vehicle. This dosage form is generally for external application to the skin or mucous membranes.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
For the temporary relief of pain due to toothaches * to help protect against infection of minor oral irritation

Regulatory & Marketing

Labeler Name
Albertsons
Product Type
Human Otc Drug
FDA Application #
M017
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
05-07-2021
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 21130-621-19 identifies a specific commercial package of 9.4 g in 1 tube of 4x Medicated Gum Cream, a human over the counter drug labeled by Albertsons. This cream is formulated for oral use and contains benzalkonium chloride; benzocaine; menthol, unspecified form; zinc chloride 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 Albertsons on May 07, 2021. The current certification is valid through December 31, 2026.

How is this Albertsons product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 21130062119. 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)
21130-621-19
11-Digit CMS (5-4-2)
21130-0621-19

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