Tricare Prenatal Dha One Rx
NDC Package 67112-402-30

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

Package Information

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

Tricare Prenatal Dha One Rx is a . Marketed by Medecor Pharma, Llc, this product is identified by NDC 67112-402.

Identification & Billing

NDC Package Code
67112-402-30
Package Description
30 CAPSULE, GELATIN COATED in 1 BOTTLE
Product Code
67112-402
11-Digit Billing Format
67112040230
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
30 EA

Clinical Specifications

Proprietary Name
Tricare Prenatal Dha One Rx Multivitamin
Dosage Form
-

Regulatory & Marketing

Labeler Name
Medecor Pharma, Llc
Marketing Category
UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
Start Marketing Date
03-15-2019
End Marketing Date
12-31-2021
Listing Expiration
12-31-2021
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.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 67112-402-30 identifies a specific commercial package of 30 capsule, gelatin coated in 1 bottle of Tricare Prenatal Dha One Rx Multivitamin, labeled by Medecor Pharma, Llc. This product is billed for "EA" each discreet unit and contains an estimated amount of 30 billable units per package. 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 Medecor Pharma, Llc on March 15, 2019. The current certification is valid through December 31, 2021.

How is this Medecor Pharma, Llc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 67112040230. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 30 total billable units per package. 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)
67112-402-30
11-Digit CMS (5-4-2)
67112-0402-30

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