Dg Health Advanced Relief Eye Drops Solution
NDC Package 55910-361-01

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

Package Information

Dg Health Advanced Relief Eye Drops (dextran 70, polyethylene glycol 400, povidone, tetrahydrozoline hcl) solution is usesrelieves redness of the eye due to minor eye irritationsas a lubricant to prevent further irritation or to relieve dryness of the eye. This formulation utilizes a solution delivery system. Marketed by Dolgencorp Llc, this product is identified by NDC 55910-361 and is authorized under FDA application M018.

Identification & Billing

NDC Package Code
55910-361-01
Package Description
1 BOTTLE, DROPPER in 1 CARTON / 15 mL in 1 BOTTLE, DROPPER
Product Code
55910-361
11-Digit Billing Format
55910036101
RxNorm Crosswalk
  • RxCUI: 996202 - dextran 70 0.1 % / polyethylene glycol 400 1 % / povidone 1 % / tetrahydrozoline HCl 0.05 % Ophthalmic Solution
  • RxCUI: 996202 - dextran 70 1 MG/ML / polyethylene glycol 400 10 MG/ML / povidone 10 MG/ML / tetrahydrozoline hydrochloride 0.5 MG/ML Ophthalmic Solution

Clinical Specifications

Proprietary Name
Dg Health Advanced Relief Eye Drops
Non-Proprietary Name
Dextran 70, Polyethylene Glycol 400, Povidone, Tetrahydrozoline Hcl
Substance Name
Dextran 70; Polyethylene Glycol 400; Povidone, Unspecified; Tetrahydrozoline Hydrochloride
Dosage Form
Solution - A clear, homogeneous liquid1 dosage form that contains one or more chemical substances dissolved in a solvent or mixture of mutually miscible solvents.
Administration Route
Ophthalmic - Administration to the external eye.
Active Ingredient(s)
Pharmacologic Class
Usage Information
Usesrelieves redness of the eye due to minor eye irritationsas a lubricant to prevent further irritation or to relieve dryness of the eye

Regulatory & Marketing

Labeler Name
Dolgencorp Llc
Product Type
Human Otc Drug
FDA Application #
M018
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
01-26-2020
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.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 55910-361-01 identifies a specific commercial package of 1 bottle, dropper in 1 carton / 15 ml in 1 bottle, dropper of Dg Health Advanced Relief Eye Drops, a human over the counter drug labeled by Dolgencorp Llc. This solution is formulated for ophthalmic use and contains dextran 70; polyethylene glycol 400; povidone, unspecified; tetrahydrozoline hydrochloride 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 Dolgencorp Llc on January 26, 2020. The current certification is valid through December 31, 2026.

How is this Dolgencorp Llc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 55910036101. 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)
55910-361-01
11-Digit CMS (5-4-2)
55910-0361-01

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