Walmart Kit
NDC Package 79903-350-12

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

Package Information

Walmart (acetaminophen, dextromethorphan hbr, diphenhydramine hcl) kits is ▪do not use more than directed▪take every 4 hours, while symptoms persist. This formulation utilizes a kit delivery system. Marketed by Wal-mart Stores Inc, this product is identified by NDC 79903-350 and is authorized under FDA application M012.

Identification & Billing

NDC Package Code
79903-350-12
Package Description
1 KIT in 1 CARTON * 6 PACKET in 1 CARTON (79903-436-06) / 1 POWDER, FOR SOLUTION in 1 PACKET * 6 PACKET in 1 CARTON (79903-439-06) / 1 POWDER, FOR SOLUTION in 1 PACKET
Product Code
79903-350
11-Digit Billing Format
79903035012
RxNorm Crosswalk
  • RxCUI: 2670598 - acetaminophen 500 MG / dextromethorphan hydrobromide 20 MG Powder for Oral Solution
  • RxCUI: 2670598 - APAP 500 MG / dextromethorphan hydrobromide 20 MG Powder for Oral Solution
  • RxCUI: 2670677 - acetaminophen 650 MG / diphenhydrAMINE HCl 25 MG Powder for Oral Solution
  • RxCUI: 2670677 - acetaminophen 650 MG / diphenhydramine hydrochloride 25 MG Powder for Oral Solution
  • RxCUI: 2670677 - acetaminophen 650 MG / diphenhydramine HCl 25 MG Granules for Oral Solution

Clinical Specifications

Proprietary Name
Walmart Daytime And Nighttime Ms Severe Relief Value Pack
Non-Proprietary Name
Acetaminophen, Dextromethorphan Hbr, Diphenhydramine Hcl
Dosage Form
Kit - A packaged collection of related material.
Usage Information
▪do not use more than directed▪take every 4 hours, while symptoms persist. Do not take more than 6 packets in 24 hours unless directed by a doctorAgeDoseAdults and children 12 years of age and overOne packetChildren under 12 years of ageDo not use▪dissolve contents of one packet into 8 oz. hot water: sip while hot. Consume entire drink within 10 - 15 minutes.▪if using a microwave, add contents of one packet to 8 oz. of cool water: stir briskly before and after heating, Do not overheat

Regulatory & Marketing

Labeler Name
Wal-mart Stores Inc
Product Type
Human Otc Drug
FDA Application #
M012
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
02-02-2026
Listing Expiration
12-31-2027
Exclude Flag
N
Sample Package
No

Hierarchy Structure

Code Lineage
  • 79903 - Wal-mart Stores Inc
    • 79903-350 - Walmart
      • 79903-350-12 - 1 KIT in 1 CARTON * 6 PACKET in 1 CARTON (79903-436-06) / 1 POWDER, FOR SOLUTION in 1 PACKET * 6 PACKET in 1 CARTON (79903-439-06) / 1 POWDER, FOR SOLUTION in 1 PACKET

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 79903-350-12 identifies a specific commercial package of 1 kit in 1 carton * 6 packet in 1 carton (79903-436-06) / 1 powder, for solution in 1 packet * 6 packet in 1 carton (79903-439-06) / 1 powder, for solution in 1 packet of Walmart Daytime And Nighttime Ms Severe Relief Value Pack, a human over the counter drug labeled by Wal-mart Stores Inc. This kit is formulated for use and contains 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 Wal-mart Stores Inc on February 02, 2026. The current certification is valid through December 31, 2027.

How is this Wal-mart Stores Inc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 79903035012. 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)
79903-350-12
11-Digit CMS (5-4-2)
79903-0350-12

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