CMS-10110 Product Data Template

Manufacturer Name

NDC1

NDC2

NDC3 Alternate ID Alternate ID Website URL

Brand Name Generic Name

Volume Per Item

Unit for Volume per Item

Number of Items Per
NDC or Alternate ID

Package Type Strength Unit for Strength

FDA Application
Number / Registration
Number

FDA Application
Supplement Number

Additional FDA
Application Number #1

Additional FDA
Application Supplement
Number #1

Additional FDA
Application Number #2

Additional FDA
Application Supplement
Number #2

FDA Approval Date

FDA Approval Type

First Marketing Date

Date of First Sale for this
Product