AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT LYSINE AND LOW IN TRYPTOPHAN

amino acid formula with vitamins and minerals without lysine and low in tryptophan containing 5 g of protein equivalent powder for oral liquid, 30 x 12.5 g sachets

AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT LYSINE AND LOW IN TRYPTOPHAN (14781Y)

amino acid formula with vitamins and minerals without lysine and low in tryptophan containing 5 g of protein equivalent powder for oral liquid, 30 x 12.5 g sachets
14781Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Proven glutaric aciduria type 1

Restriction

Indication: Pyridoxine dependent epilepsy
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: $1,832.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
GA explore5