Epsom Salt Granule
NDC Package 21130-970-04

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

Package Information

Epsom Salt (magnesium sulfate) granules is do not exceed more than 2 doses per day; if necessary repeat dosage in 4 hoursagedose adults and children 12  years and older 2-4 level teaspoons dissolved in a full glass (8oz) of water  children 6 to 11 years1-2 level teaspoons dissolved in a full glass (8oz) of waterNot recommended for children under 6 years of age. This formulation utilizes a granule delivery system. Marketed by Safeway, Inc., this product is identified by NDC 21130-970 and is authorized under FDA application M007.

Identification & Billing

NDC Package Code
21130-970-04
Package Description
1814 g in 1 POUCH
Product Code
21130-970
11-Digit Billing Format
21130097004
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Epsom Salt
Non-Proprietary Name
Magnesium Sulfate
Substance Name
Magnesium Sulfate, Unspecified
Dosage Form
Granule - A small particle or grain.
Administration Route
  • Oral - Administration to or by way of the mouth.
  • Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
MAGNESIUM SULFATE, UNSPECIFIED 1 g/g
Pharmacologic Class
Usage Information
Do not exceed more than 2 doses per day; if necessary repeat dosage in 4 hoursagedose adults and children 12  years and older 2-4 level teaspoons dissolved in a full glass (8oz) of water  children 6 to 11 years1-2 level teaspoons dissolved in a full glass (8oz) of waterNot recommended for children under 6 years of age.

Regulatory & Marketing

Labeler Name
Safeway, Inc.
Product Type
Human Otc Drug
FDA Application #
M007
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
02-01-2023
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 21130-970-04 identifies a specific commercial package of 1814 g in 1 pouch of Epsom Salt, a human over the counter drug labeled by Safeway, Inc.. This granule is formulated for oral; topical use and contains magnesium sulfate, unspecified 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, Inc. on February 01, 2023. The current certification is valid through December 31, 2026.

How is this Safeway, Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 21130097004. 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)
21130-970-04
11-Digit CMS (5-4-2)
21130-0970-04

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