AMINO ACID FORMULA WITH FAT, CARBOHYDRATE, VITAMINS AND MINERALS WITHOUT PHENYLALANINE

amino acid formula with fat, carbohydrate, vitamins and minerals without phenylalanine tablet: modified release, 6 x 100 g

AMINO ACID FORMULA WITH FAT, CARBOHYDRATE, VITAMINS AND MINERALS WITHOUT PHENYLALANINE (14782B)

amino acid formula with fat, carbohydrate, vitamins and minerals without phenylalanine tablet: modified release, 6 x 100 g
14782B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Phenylketonuria
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 7 Max qty units: 7 # of repeats: 5 DPMQ: $1,737.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PKU Easy Microtabs Plus