AMINO ACID FORMULA WITH FAT, CARBOHYDRATE WITHOUT METHIONINE

amino acid formula with fat, carbohydrate without methionine modified release tablet, 6 x 77

AMINO ACID FORMULA WITH FAT, CARBOHYDRATE WITHOUT METHIONINE (12006X)

amino acid formula with fat, carbohydrate without methionine modified release tablet, 6 x 77
12006X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Pyridoxine non-responsive homocystinuria
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 5 Max qty units: 5 # of repeats: 5 DPMQ: $2,823.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
HCU Easy Tablet