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NDC 00065-0454-07 Systane 4; 3 mg/mL; mg/mL Details
Systane 4; 3 mg/mL; mg/mL
Systane is a OPHTHALMIC GEL in the HUMAN OTC DRUG category. It is labeled and distributed by Alcon Laboratories, Inc.. The primary component is POLYETHYLENE GLYCOL 400; PROPYLENE GLYCOL.
Product Information
| NDC | 00065-0454 |
|---|---|
| Product ID | 0065-0454_6c8fa8af-e9bf-49b3-9d5c-f1cb73de2fdd |
| Associated GPIs | 86209902484020 |
| GCN Sequence Number | 067277 |
| GCN Sequence Number Description | propylene glycol/peg 400 DROPS GEL 0.3 %-0.4% OPHTHALMIC |
| HIC3 | Q6T |
| HIC3 Description | ARTIFICIAL TEARS |
| GCN | 29804 |
| HICL Sequence Number | 025225 |
| HICL Sequence Number Description | PROPYLENE GLYCOL/POLYETHYLENE GLYCOL 400 |
| Brand/Generic | Brand |
| Proprietary Name | Systane |
| Proprietary Name Suffix | n/a |
| Non-Proprietary Name | polyethylene glycol 400 and propylene glycol |
| Product Type | HUMAN OTC DRUG |
| Dosage Form | GEL |
| Route | OPHTHALMIC |
| Active Ingredient Strength | 4; 3 |
| Active Ingredient Units | mg/mL; mg/mL |
| Substance Name | POLYETHYLENE GLYCOL 400; PROPYLENE GLYCOL |
| Labeler Name | Alcon Laboratories, Inc. |
| Pharmaceutical Class | n/a |
| DEA Schedule | n/a |
| Marketing Category | OTC MONOGRAPH DRUG |
| Application Number | M018 |
| Listing Certified Through | 2024-12-31 |
Package
NDC 00065-0454-07 (00065045407)
| NDC Package Code | 0065-0454-07 |
|---|---|
| Billing NDC | 00065045407 |
| Package | 10 mL in 1 BOTTLE, DROPPER (0065-0454-07) |
| Marketing Start Date | 2011-02-11 |
| NDC Exclude Flag | N |
| Pricing Information | |
| Price Per Unit | 1.084 |
| Pricing Unit | ML |
| Effective Date | 2023-12-20 |
| NDC Description | SYSTANE GEL EYE DROPS |
| Pharmacy Type Indicator | C/I |
| OTC | Y |
| Explanation Code | 4, 5, 6 |
| Classification for Rate Setting | B |
| As of Date | 2024-02-21 |
This pricing file, entitled the NADAC (National Average Drug Acquisition
Cost) files, provide
state Medicaid agencies with covered outpatient drug prices by averaging
survey invoice
prices from retail community pharmacies across the United States. These
pharmacies include
independent retail community pharmacies and chain pharmacies. The prices
are updated on a
weekly and monthly basis