Benzethonium Chloride Plus Dyclonine Hydrochloride
NDC Package 56104-040-03

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

Package Information

This product is EXCLUDED from the official NDC directory because the listing data was discontinued by the firm.

Benzethonium Chloride Plus Dyclonine Hydrochloride is a . Marketed by Premier Brands Of America Inc., this product is identified by NDC 56104-040 and is authorized under FDA application M003.

Identification & Billing

NDC Package Code
56104-040-03
Package Description
9 mL in 1 BOTTLE, WITH APPLICATOR
Product Code
56104-040
11-Digit Billing Format
56104004003

Clinical Specifications

Proprietary Name
Benzethonium Chloride Plus Dyclonine Hydrochloride
Dosage Form
-

Regulatory & Marketing

Labeler Name
Premier Brands Of America Inc.
FDA Application #
M003
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
01-03-2018
End Marketing Date
01-03-2020
Listing Expiration
01-03-2020
Exclude Flag
D
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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (56104-040). Click a package code to view its specific billing and regulatory data.

56104-040-30
30 mL in 1 BOTTLE

* 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 56104-040-03 identifies a specific commercial package of 9 ml in 1 bottle, with applicator of Benzethonium Chloride Plus Dyclonine Hydrochloride, labeled by Premier Brands Of America 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 Premier Brands Of America Inc. on January 03, 2018. The current certification is valid through January 03, 2020.

How is this Premier Brands Of America Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 56104004003. 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)
56104-040-03
11-Digit CMS (5-4-2)
56104-0040-03

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