Winco Pure 5lb Crystal
NDC Package 67091-477-04

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

Package Information

Winco Pure 5lb (pure 5lb epsom salt) crystals is do not exceed more than 2 doses per day; if necessary repeat dosage in 4 hoursAgeDoseadults and children 12 years and older2-4 level teaspoons dissolved in a full glass (8oz) of waterchildren 6-11 years1-2 level teaspoons dissolved in a full glass (8oz) of waterNot recommended for children under 6 years of age. This formulation utilizes a crystal delivery system. Marketed by Winco Foods, Llc, this product is identified by NDC 67091-477 and is authorized under FDA application M007.

Identification & Billing

NDC Package Code
67091-477-04
Package Description
6 BAG in 1 BOX / 2270 g in 1 BAG
Product Code
67091-477
11-Digit Billing Format
67091047704

Clinical Specifications

Proprietary Name
Winco Pure 5lb
Non-Proprietary Name
Pure 5lb Epsom Salt
Substance Name
Magnesium Sulfate, Unspecified
Dosage Form
Crystal - A naturally produced angular solid of definite form in which the ultimate units from which it is built up are systematically arranged; they are usually evenly spaced on a regular space lattice.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
MAGNESIUM SULFATE, UNSPECIFIED 1 g/g
Pharmacologic Class
Usage Information
Do not exceed more than 2 doses per day; if necessary repeat dosage in 4 hoursAgeDoseadults and children 12 years and older2-4 level teaspoons dissolved in a full glass (8oz) of waterchildren 6-11 years1-2 level teaspoons dissolved in a full glass (8oz) of waterNot recommended for children under 6 years of age

Regulatory & Marketing

Labeler Name
Winco Foods, Llc
Product Type
Human Otc Drug
FDA Application #
M007
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
08-05-2026
Listing Expiration
12-31-2027
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 67091-477-04 identifies a specific commercial package of 6 bag in 1 box / 2270 g in 1 bag of Winco Pure 5lb, a human over the counter drug labeled by Winco Foods, Llc. This crystal is formulated for oral use and contains magnesium sulfate, unspecified 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 August 05, 2026. The current certification is valid through December 31, 2027.

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

For medical billing and reimbursement, this package follows the 11-digit CMS format: 67091047704. 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)
67091-477-04
11-Digit CMS (5-4-2)
67091-0477-04

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