Sitagliptin Tablet, Film Coated
NDC Package 84677-050-90

11-digit billing NDC: 84677005090 · Billing unit: EA · 90 EA per package
Table of Contents
    1. Package Information
    2. Frequently Asked Questions

Package Information

Sitagliptin tablets is  are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.Limitations of UseSitagliptin tablets should not be used in patients with type 1 diabetes.Sitagliptin has not been studied in patients with a history of pancreatitis. This formulation utilizes a tablet, film coated delivery system. Marketed by Golden State Medical Supply, Inc., this product is identified by NDC 84677-050 and is authorized under FDA application ANDA202425.

Identification & Billing

NDC Package Code
84677-050-90
Package Description
90 TABLET, FILM COATED in 1 BOTTLE, PLASTIC
Product Code
84677-050
11-Digit Billing Format
84677005090
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
90 EA
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Sitagliptin
Non-Proprietary Name
Sitagliptin
Substance Name
Sitagliptin Phosphate
Dosage Form
Tablet, Film Coated - A solid dosage form that contains medicinal substances with or without suitable diluents and is coated with a thin layer of a water-insoluble or water-soluble polymer.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
SITAGLIPTIN PHOSPHATE 50 mg/1
Pharmacologic Class
Usage Information
Sitagliptin tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.Limitations of UseSitagliptin tablets should not be used in patients with type 1 diabetes.Sitagliptin has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using sitagliptin  [See Warnings and Precautions ( 5.1)].

Regulatory & Marketing

Labeler Name
Golden State Medical Supply, Inc.
Product Type
Human Prescription Drug
FDA Application #
ANDA202425
Marketing Category
ANDA - A product marketed under an approved Abbreviated New Drug Application.
Start Marketing Date
01-20-2026
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 84677-050-90 identifies a specific commercial package of 90 tablet, film coated in 1 bottle, plastic of Sitagliptin, a human prescription drug labeled by Golden State Medical Supply, Inc.. This product is billed for "EA" each discreet unit and contains an estimated amount of 90 billable units per package. This tablet, film coated is formulated for oral use and contains sitagliptin phosphate 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 Golden State Medical Supply, Inc. on January 20, 2026. The current certification is valid through December 31, 2027.

How is this Golden State Medical Supply, Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 84677005090. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 90 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)
84677-050-90
11-Digit CMS (5-4-2)
84677-0050-90

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