Dollar General Medicated Pain Relief Patch
NDC Package 55910-907-20

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

Package Information

Dollar General Medicated Pain Relief Patch (camphor, menthol, methyl salicylate) patches is adults and children 12 years of age and over: Clean and dry affected area. This formulation utilizes a patch delivery system. Marketed by Dolgencorp, Llc, this product is identified by NDC 55910-907 and is authorized under FDA application part348.

Identification & Billing

NDC Package Code
55910-907-20
Package Description
20 PATCH in 1 BOX / 9 g in 1 PATCH
Product Code
55910-907
11-Digit Billing Format
55910090720
RxNorm Crosswalk
  • RxCUI: 1793147 - camphor 3.1 % / menthol 6 % / methyl salicylate 10 % Medicated Patch
  • RxCUI: 1793147 - camphor 0.031 MG/MG / menthol 0.06 MG/MG / methyl salicylate 0.1 MG/MG Medicated Patch

Clinical Specifications

Proprietary Name
Dollar General Medicated Pain Relief Patch
Non-Proprietary Name
Camphor, Menthol, Methyl Salicylate
Substance Name
Camphor (synthetic); Menthol; Methyl Salicylate
Dosage Form
Patch - A drug delivery system that often contains an adhesive backing that is usually applied to an external site on the body. Its ingredients either passively diffuse from, or are actively transported from, some portion of the patch. Depending upon the patch, the ingredients are either delivered to the outer surface of the body or into the body. A patch is sometimes synonymous with the terms ‘extended release film’ and ‘system’.
Administration Route
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)
Usage Information
Adults and children 12 years of age and over: Clean and dry affected area. Remove patch from film, apply to affected area not more than 3 to 4 times daily. Remove patch from the skin after at most, 8-hour application.Children under 12 years of age: consult physician.

Regulatory & Marketing

Labeler Name
Dolgencorp, Llc
Product Type
Human Otc Drug
FDA Application #
part348
Marketing Category
OTC MONOGRAPH NOT FINAL - A product marketed pursuant to an Over-the-Counter (OTC) Drug Monograph that is not final.
Start Marketing Date
10-01-2017
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 55910-907-20 identifies a specific commercial package of 20 patch in 1 box / 9 g in 1 patch of Dollar General Medicated Pain Relief Patch, a human over the counter drug labeled by Dolgencorp, Llc. This patch is formulated for topical use and contains camphor (synthetic); menthol; methyl salicylate 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 October 01, 2017. 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: 55910090720. 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)
55910-907-20
11-Digit CMS (5-4-2)
55910-0907-20

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