Sitagliptin And Metformin Hydrochloride Tablet, Film Coated
NDC Package 84677-053-18

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

Package Information

Sitagliptin And Metformin Hydrochloride tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.Limitations of UseSitagliptin and metformin hydrochloride tablets should not be used in patients with type 1 diabetes mellitus.Sitagliptin and metformin hydrochloride tablets have 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 84677-053 and is authorized under FDA application ANDA202426.

Identification & Billing

NDC Package Code
84677-053-18
Package Description
180 TABLET, FILM COATED in 1 BOTTLE
Product Code
84677-053
11-Digit Billing Format
84677005318

Clinical Specifications

Proprietary Name
Sitagliptin And Metformin Hydrochloride
Non-Proprietary Name
Sitagliptin And Metformin Hydrochloride
Substance Name
Sitagliptin Phosphate; Metformin Hydrochloride
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)
Pharmacologic Class
Usage Information
Sitagliptin and metformin hydrochloride tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.Limitations of UseSitagliptin and metformin hydrochloride tablets should not be used in patients with type 1 diabetes mellitus.Sitagliptin and metformin hydrochloride tablets have 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 and metformin hydrochloride tablets [see Warnings and Precautions (5.2)].

Regulatory & Marketing

Labeler Name
Golden State Medical Supply, Inc.
Product Type
Human Prescription Drug
FDA Application #
ANDA202426
Marketing Category
ANDA - A product marketed under an approved Abbreviated New Drug Application.
Start Marketing Date
04-30-2026
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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (84677-053). Click a package code to view its specific billing and regulatory data.

84677-053-60
60 TABLET, FILM COATED in 1 BOTTLE

* 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 84677-053-18 identifies a specific commercial package of 180 tablet, film coated in 1 bottle of Sitagliptin And Metformin Hydrochloride, a human prescription drug labeled by Golden State Medical Supply, Inc.. This tablet, film coated is formulated for oral use and contains sitagliptin phosphate; metformin 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 Golden State Medical Supply, Inc. on April 30, 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: 84677005318. 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)
84677-053-18
11-Digit CMS (5-4-2)
84677-0053-18

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