Petroleum Jelly
NDC Package 87236-009-04

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

Petroleum Jelly (white petrolatum) jellies is as a skin protectant:apply as needed For diaper rash: Change wet and soiled diaper promptly, cleanse the diaper area, and allow to dry. This formulation utilizes a jelly delivery system. Marketed by Aldermed Inc., this product is identified by NDC 87236-009 and is authorized under FDA application M016.

Identification & Billing

NDC Package Code
87236-009-04
Package Description
113 g in 1 TUBE
Product Code
87236-009
11-Digit Billing Format
87236000904
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Petroleum Jelly
Non-Proprietary Name
White Petrolatum
Substance Name
White Petrolatum
Dosage Form
Jelly - A class of gels, which are semisolid systems that consist of suspensions made up of either small inorganic particles or large organic molecules interpenetrated by a liquid--in which the structural coherent matrix contains a high portion of liquid, usually water.
Administration Route
Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
WHITE PETROLATUM 1 g/g
Usage Information
As a skin protectant:apply as needed For diaper rash: Change wet and soiled diaper promptly, cleanse the diaper area, and allow to dry. Apply jelly liberally as often as necessary, with each diaper change, especially at bed-time or anytime when exposure to wet diapers may be prolonged.

Regulatory & Marketing

Labeler Name
Aldermed Inc.
Product Type
Human Otc Drug
FDA Application #
M016
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
12-01-2025
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 (87236-009). Click a package code to view its specific billing and regulatory data.

87236-009-01
1 TUBE in 1 CARTON / 28.4 g in 1 TUBE
87236-009-02
56.6 g in 1 TUBE
87236-009-05
5 g in 1 PACKET
87236-009-13
368 g in 1 JAR
87236-009-15
425 g in 1 JAR
87236-009-44
144 PACKET in 1 CARTON / 5 g in 1 PACKET
87236-009-56
1 TUBE in 1 CARTON / 56.6 g in 1 TUBE

* 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 87236-009-04 identifies a specific commercial package of 113 g in 1 tube of Petroleum Jelly, a human over the counter drug labeled by Aldermed Inc.. This jelly is formulated for topical use and contains white petrolatum 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 Aldermed Inc. on December 01, 2025. The current certification is valid through December 31, 2027.

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

For medical billing and reimbursement, this package follows the 11-digit CMS format: 87236000904. 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)
87236-009-04
11-Digit CMS (5-4-2)
87236-0009-04

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