Winco Foods Effervescent Antacid And Pain Relief Tablet, Effervescent
NDC Package 67091-108-36

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

Package Information

Winco Foods Effervescent Antacid And Pain Relief (aspirin, sodium bicarbonate, citric acid tablet) tablets is usesfor the temporary relief of■ heartburn, acid indigestion and sour stomach when accompanied by headache or body aches and pains■ upset stomach with headache from overindulgence in food or drink■ pain alone (headaches or body aches and pains). This formulation utilizes a tablet, effervescent delivery system. Marketed by Winco Foods, Llc, this product is identified by NDC 67091-108 and is authorized under FDA application M013.

Identification & Billing

NDC Package Code
67091-108-36
Package Description
18 POUCH in 1 CARTON / 2 TABLET, EFFERVESCENT in 1 POUCH
Product Code
67091-108
11-Digit Billing Format
67091010836
RxNorm Crosswalk
  • RxCUI: 1536675 - aspirin 325 MG / citric acid 1000 MG / sodium bicarbonate 1916 MG Effervescent Oral Tablet
  • RxCUI: 1536675 - ASA 325 MG / Citric Acid 1000 MG / NaHCO3 1916 MG Effervescent Oral Tablet

Clinical Specifications

Proprietary Name
Winco Foods Effervescent Antacid And Pain Relief
Non-Proprietary Name
Aspirin, Sodium Bicarbonate, Citric Acid Tablet
Substance Name
Anhydrous Citric Acid; Aspirin; Sodium Bicarbonate
Dosage Form
Tablet, Effervescent - A solid dosage form containing mixtures of acids (e.g., citric acid, tartaric acid) and sodium bicarbonate, which release carbon dioxide when dissolved in water; it is intended to be dissolved or dispersed in water before administration.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
Usesfor the temporary relief of■ heartburn, acid indigestion and sour stomach when accompanied by headache or body aches and pains■ upset stomach with headache from overindulgence in food or drink■ pain alone (headaches or body aches and pains)

Regulatory & Marketing

Labeler Name
Winco Foods, Llc
Product Type
Human Otc Drug
FDA Application #
M013
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
01-01-2015
End Marketing Date
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 67091-108-36 identifies a specific commercial package of 18 pouch in 1 carton / 2 tablet, effervescent in 1 pouch of Winco Foods Effervescent Antacid And Pain Relief, a human over the counter drug labeled by Winco Foods, Llc. This tablet, effervescent is formulated for oral use and contains anhydrous citric acid; aspirin; sodium bicarbonate 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 Winco Foods, Llc on January 01, 2015.

How is this Winco Foods, Llc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 67091010836. 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)
67091-108-36
11-Digit CMS (5-4-2)
67091-0108-36

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