Sal De Uvas Picot Granule, Effervescent
NDC Package 67751-174-01

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

Package Information

Sal De Uvas Picot (citric acid monohydrate, sodium bicarbonate) granules is fully dissolve one packet in 1/2 glass of water before takingadults 60 years and over 1 packet every 4 hours, or as directed by a doctor. This formulation utilizes a granule, effervescent delivery system. Marketed by Navajo Manufacturing Company Inc., this product is identified by NDC 67751-174 and is authorized under FDA application M001.

Identification & Billing

NDC Package Code
67751-174-01
Package Description
1 POUCH in 1 CARTON / 1 GRANULE, EFFERVESCENT in 1 POUCH
Product Code
67751-174
11-Digit Billing Format
67751017401
RxNorm Crosswalk
  • RxCUI: 1795948 - citric acid 1.949 GM / sodium bicarbonate 2.485 GM Powder for Oral Solution
  • RxCUI: 1795948 - citric acid 1949 MG / sodium bicarbonate 2485 MG Powder for Oral Solution
  • RxCUI: 1795948 - Citric Acid 1949 MG / NaHCO3 2485 MG Powder for Oral Solution
  • RxCUI: 1795950 - picot 1.949 GM / 2.485 GM Powder for Oral Solution
  • RxCUI: 1795950 - citric acid 1949 MG / sodium bicarbonate 2485 MG Powder for Oral Solution [Picot]

Clinical Specifications

Proprietary Name
Sal De Uvas Picot
Non-Proprietary Name
Citric Acid Monohydrate, Sodium Bicarbonate
Substance Name
Citric Acid Monohydrate; Sodium Bicarbonate
Dosage Form
Granule, Effervescent - A small particle or grain containing a medicinal agent in a dry mixture usually composed of sodium bicarbonate, citric acid, and tartaric acid which, when in contact with water, has the capability to release gas, resulting in effervescence.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
Fully dissolve one packet in 1/2 glass of water before takingadults 60 years and over 1 packet every 4 hours, or as directed by a doctor. Do not exceed 3 packets in 24 hoursadults and children 12 to 60 years one packet every 4 hours or as directed by a doctor. Do not exceed 4 packets in 24 hourschildren under 12 years  ask a doctor

Regulatory & Marketing

Labeler Name
Navajo Manufacturing Company Inc.
Product Type
Human Otc Drug
FDA Application #
M001
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
09-23-2016
Listing Expiration
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 67751-174-01 identifies a specific commercial package of 1 pouch in 1 carton / 1 granule, effervescent in 1 pouch of Sal De Uvas Picot, a human over the counter drug labeled by Navajo Manufacturing Company Inc.. This granule, effervescent is formulated for oral use and contains citric acid monohydrate; 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 Navajo Manufacturing Company Inc. on September 23, 2016. The current certification is valid through December 31, 2026.

How is this Navajo Manufacturing Company Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 67751017401. 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)
67751-174-01
11-Digit CMS (5-4-2)
67751-0174-01

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