Folvitra Tablet
NDC Package 85622-004-30

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

Package Information

Folvitra (folic acid, vitamin d3) tablets is classified as a

administered via oral route. This formulation utilizes a tablet delivery system. Marketed by Blue Heron Pharmaceuticals, Llc, this product is identified by NDC 85622-004.

Identification & Billing

NDC Package Code
85622-004-30
Package Description
30 TABLET in 1 BOTTLE
Product Code
85622-004
11-Digit Billing Format
85622000430
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
30 EA
RxNorm Crosswalk
  • RxCUI: 1720258 - vitamin D3 125 MCG (5000 UNT) / folate 1700 MCG DFE (1000 mcg folic acid) Oral Tablet
  • RxCUI: 1720258 - cholecalciferol 5000 UNT / folic acid 1 MG Oral Tablet
  • RxCUI: 1720258 - Cholecalciferol 5000 UNT / folate 1 MG Oral Tablet
  • RxCUI: 1720258 - vitamin D3 125 MCG / folic acid 1000 MCG Oral Tablet
  • RxCUI: 1720258 - vitamin D3 5000 UNT / folic acid 1 MG Oral Tablet

Clinical Specifications

Proprietary Name
Folvitra
Non-Proprietary Name
Folic Acid, Vitamin D3
Substance Name
Cholecalciferol; Folic Acid
Dosage Form
Tablet - A solid dosage form containing medicinal substances with or without suitable diluents.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class

Regulatory & Marketing

Labeler Name
Blue Heron Pharmaceuticals, Llc
Product Type
Human Prescription Drug
Marketing Category
UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
Start Marketing Date
09-11-2025
Listing Expiration
12-31-2026
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 85622-004-30 identifies a specific commercial package of 30 tablet in 1 bottle of Folvitra, a human prescription drug labeled by Blue Heron Pharmaceuticals, Llc. This product is billed for "EA" each discreet unit and contains an estimated amount of 30 billable units per package. This tablet is formulated for oral use and contains cholecalciferol; folic acid 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 Blue Heron Pharmaceuticals, Llc on September 11, 2025. The current certification is valid through December 31, 2026.

How is this Blue Heron Pharmaceuticals, Llc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 85622000430. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 30 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)
85622-004-30
11-Digit CMS (5-4-2)
85622-0004-30

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