AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT VALINE, LEUCINE AND ISOLEUCINE

amino acid formula with vitamins and minerals without valine, leucine and isoleucine powder for oral liquid, 500 g

AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT VALINE, LEUCINE AND ISOLEUCINE (8057C)

amino acid formula with vitamins and minerals without valine, leucine and isoleucine powder for oral liquid, 500 g
8057C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Maple syrup urine disease
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: $2,241.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
MSUD Maxamum