Pain Relieving Cleansing Spary Spray
NDC Package 69396-177-05

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

Package Information

Pain Relieving Cleansing Spary (benzalkonium chloride and lidocaine hci) sprays is ​Adults and children 2 years of age and older:Clean the affected areaSpray a small amount of this product to the affected area up to 3 times daily.May be covered with a sterile bandage, let dry firstChildren under 2 years of age do not use, ask a doctor before use. This formulation utilizes a spray delivery system. Marketed by Trifecta Pharmaceuticals Usa, Llc., this product is identified by NDC 69396-177 and is authorized under FDA application M017.

Identification & Billing

NDC Package Code
69396-177-05
Package Description
148 mL in 1 BOTTLE, SPRAY
Product Code
69396-177
11-Digit Billing Format
69396017705
RxNorm Crosswalk
  • RxCUI: 2047877 - benzalkonium chloride 0.13 % / lidocaine HCl 4 % Topical Spray
  • RxCUI: 2047877 - benzalkonium chloride 1.3 MG/ML / lidocaine hydrochloride 40 MG/ML Topical Spray

Clinical Specifications

Proprietary Name
Pain Relieving Cleansing Spary
Non-Proprietary Name
Benzalkonium Chloride And Lidocaine Hci
Substance Name
Benzalkonium Chloride; Lidocaine Hydrochloride
Dosage Form
Spray - A liquid minutely divided as by a jet of air or steam.
Administration Route
Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
Pharmacologic Class
Usage Information
​Adults and children 2 years of age and older:Clean the affected areaSpray a small amount of this product to the affected area up to 3 times daily.May be covered with a sterile bandage, let dry firstChildren under 2 years of age do not use, ask a doctor before use.

Regulatory & Marketing

Labeler Name
Trifecta Pharmaceuticals Usa, Llc.
Product Type
Human Otc Drug
FDA Application #
M017
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
01-21-2026
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 69396-177-05 identifies a specific commercial package of 148 ml in 1 bottle, spray of Pain Relieving Cleansing Spary, a human over the counter drug labeled by Trifecta Pharmaceuticals Usa, Llc.. This spray is formulated for topical use and contains benzalkonium chloride; lidocaine hydrochloride 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 Trifecta Pharmaceuticals Usa, Llc. on January 21, 2026. The current certification is valid through December 31, 2027.

How is this Trifecta Pharmaceuticals Usa, Llc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 69396017705. 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)
69396-177-05
11-Digit CMS (5-4-2)
69396-0177-05

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