Equate Pain Relief Pm Solution
NDC Package 79903-421-12

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

Package Information

Equate Pain Relief Pm (acetaminophen, diphenhydramine hydrochloride) solution is •take only one dose (30 mL) per day (24 hours)•only use the dose cup provided•take only as directed – see Overdose warningadults & children 12 yrs & over30 mL at bedtimechildren under 12 yrsdo not use. This formulation utilizes a solution delivery system. Marketed by Walmart Inc., this product is identified by NDC 79903-421 and is authorized under FDA application M013.

Identification & Billing

NDC Package Code
79903-421-12
Package Description
355 mL in 1 BOTTLE
Product Code
79903-421
11-Digit Billing Format
79903042112
RxNorm Crosswalk
  • RxCUI: 1092373 - acetaminophen 500 MG / diphenhydrAMINE HCl 25 MG in 15 mL Oral Solution
  • RxCUI: 1092373 - acetaminophen 33.3 MG/ML / diphenhydramine hydrochloride 1.67 MG/ML Oral Solution
  • RxCUI: 1092373 - acetaminophen 1000 MG / diphenhydramine HCl 50 MG per 30 ML Oral Solution
  • RxCUI: 1092373 - acetaminophen 500 MG / diphenhydramine HCl 25 MG per 15 ML Oral Solution
  • RxCUI: 1092373 - APAP 33.3 MG/ML / Diphenhydramine Hydrochloride 1.67 MG/ML Oral Solution

Clinical Specifications

Proprietary Name
Equate Pain Relief Pm
Non-Proprietary Name
Acetaminophen, Diphenhydramine Hydrochloride
Substance Name
Acetaminophen; Diphenhydramine Hydrochloride
Dosage Form
Solution - A clear, homogeneous liquid1 dosage form that contains one or more chemical substances dissolved in a solvent or mixture of mutually miscible solvents.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
•take only one dose (30 mL) per day (24 hours)•only use the dose cup provided•take only as directed – see Overdose warningadults & children 12 yrs & over30 mL at bedtimechildren under 12 yrsdo not use

Regulatory & Marketing

Labeler Name
Walmart Inc.
Product Type
Human Otc Drug
FDA Application #
M013
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
04-29-2026
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 79903-421-12 identifies a specific commercial package of 355 ml in 1 bottle of Equate Pain Relief Pm, a human over the counter drug labeled by Walmart Inc.. This solution is formulated for oral use and contains acetaminophen; diphenhydramine 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 Walmart Inc. on April 29, 2026. The current certification is valid through December 31, 2027.

How is this Walmart Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 79903042112. 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)
79903-421-12
11-Digit CMS (5-4-2)
79903-0421-12

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