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  5. NDC Package Code: 63940-762-04 Polyethylene Glycol

NDC Package 63940-762-04 Polyethylene Glycol

View Billable Units, 11-Digit Format, RxNorm

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 inactivated by the FDA.

Find all the important details about this NDC Package code, including the 11-Digit NDC Billing number, billing units, wholesale price, RxNorm crosswalk, active ingredients, pharmacologic clasess, etc.

NDC Package Code:
63940-762-04
Package Description:
238 g in 1 BOTTLE
Product Code:
63940-762
Proprietary Name:
Polyethylene Glycol
Usage Information:
Do not take more than directed unless advised by your doctorthe bottle top is a measuring cap marked to contain 17 grams of powder when filled to the indicated line (white section in cap)adults and children 17 years of age and older:fill to top of white section in cap which is marked to indicate the correct dose (17 g)stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room temperature) then drinkuse once a dayuse no more than 7 dayschildren 16 years of age or under: ask a doctor
11-Digit NDC Billing Format:
63940076204
NDC to RxNorm Crosswalk:
  • RxCUI: 876193 - polyethylene glycol 3350 17 GM Powder for Oral Solution
  • RxCUI: 876193 - polyethylene glycol 3350 17000 MG Powder for Oral Solution
    • Labeler Name:
    Harmon Stores, Inc
    Sample Package:
    No
    Start Marketing Date:
    08-24-2016
    Listing Expiration Date:
    12-31-2018
    Exclude Flag:
    I
    Code Structure:

    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 disclaimer below.

    Other Product Packages

    The following packages are also available for this product:

    NDC Package CodePackage Description
    63940-762-03119 g in 1 BOTTLE
    63940-762-05510 g in 1 BOTTLE

    * Please review the disclaimer below.

    Frequently Asked Questions

    What is NDC 63940-762-04?

    The NDC Packaged Code 63940-762-04 is assigned to a package of 238 g in 1 bottle of Polyethylene Glycol, labeled by Harmon Stores, Inc. The product's dosage form is and is administered via form.

    Is NDC 63940-762 included in the NDC Directory?

    No, Polyethylene Glycol with product code 63940-762 is excluded from the NDC Directory because it's listing has been INACTIVATED by FDA. The product was first marketed by Harmon Stores, Inc on August 24, 2016 and its listing in the NDC Directory is set to expire on December 31, 2018 if the product is not updated or renewed by the manufacturer.

    What is the 11-digit format for NDC 63940-762-04?

    The 11-digit format is 63940076204. The 11-digit billing format might be required by the Centers for Medicare & Medicaid Services (CMS) and other payers in billing claim forms.

    This package code is originally configured in a 5-3-2 segment 10-digit format and by adding a zero within the original NDC package code we can obtain the converted 11-digit format in a 5-4-2 segment configuration. The table below shows the 11-digit code conversion:

    10-Digit Format10-Digit Original Code11-Digit Format11-Digit Code
    5-3-263940-762-045-4-263940-0762-04