Hyvee
NDC Package 42507-554-17

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

Package Information

This product is EXCLUDED from the official NDC directory because the listing data was inactivated by the FDA.

Hyvee is ​Adults and children 6 years of age and older:​use once a day after brushing your teeth with toothpastevigorously swish 10 mL of rinse between your teeth for 1 minute and then spit outdo not swallow the rinsedo not eat or drink for 30 minutes after rinsingsupervise children as necessary until capable of using without supervision​Children under 6 years of age: consult a dentist or doctor. Marketed by Hyvee Inc., this product is identified by NDC 42507-554 and is authorized under FDA application part355.

Identification & Billing

NDC Package Code
42507-554-17
Package Description
473 mL in 1 BOTTLE, PLASTIC
Product Code
42507-554
11-Digit Billing Format
42507055417
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Hyvee Anticavity Mint
Dosage Form
-
Usage Information
​Adults and children 6 years of age and older:​use once a day after brushing your teeth with toothpastevigorously swish 10 mL of rinse between your teeth for 1 minute and then spit outdo not swallow the rinsedo not eat or drink for 30 minutes after rinsingsupervise children as necessary until capable of using without supervision​Children under 6 years of age: consult a dentist or doctor.

Regulatory & Marketing

Labeler Name
Hyvee Inc.
FDA Application #
part355
Marketing Category
OTC MONOGRAPH FINAL - A product marketed pursuant to a final Over-the-Counter (OTC) Drug Monograph.
Start Marketing Date
11-29-2015
Listing Expiration
12-31-2019
Exclude Flag
I
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 42507-554-17 identifies a specific commercial package of 473 ml in 1 bottle, plastic of Hyvee Anticavity Mint, labeled by Hyvee Inc.. This is formulated for use and contains as the active substance.

Is this product currently listed with the FDA?

This product code is currently listed as inactive or excluded from the primary directory. It was introduced to the market by Hyvee Inc. on November 29, 2015. The current certification is valid through December 31, 2019.

How is this Hyvee Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 42507055417. 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)
42507-554-17
11-Digit CMS (5-4-2)
42507-0554-17

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