AMINO ACID FORMULA WITH VITAMINS AND MINERALS, WITHOUT METHIONINE AND SUPPLEMENTED WITH ARACHIDONIC ACID AND DOCOSAHEXAENOIC ACID

amino acid formula with vitamins and minerals, without methionine and supplemented with arachidonic acid and docosahexaenoic acid containing 5 g of protein equivalent powder for oral liquid, 30 x 12.5 g sachets

AMINO ACID FORMULA WITH VITAMINS AND MINERALS, WITHOUT METHIONINE AND SUPPLEMENTED WITH ARACHIDONIC ACID AND DOCOSAHEXAENOIC ACID (14114W)

amino acid formula with vitamins and minerals, without methionine and supplemented with arachidonic acid and docosahexaenoic acid containing 5 g of protein equivalent powder for oral liquid, 30 x 12.5 g sachets
14114W
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: 8 Max qty units: 8 # of repeats: 5 DPMQ: $1,744.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
HCU explore5