AMINO ACID FORMULA WITH CARBOHYDRATE WITHOUT PHENYLALANINE
amino acid formula with carbohydrate without phenylalanine modified release tablet,
6 x 77
AMINO ACID FORMULA WITH CARBOHYDRATE WITHOUT PHENYLALANINE (12072J)
12072J
Body System:
Manner of administration:Oral
Restriction
Indication: Phenylketonuria
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $1,260.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Easy Tablet | |||||