AMINO ACID FORMULA WITHOUT PHENYLALANINE
amino acid formula without phenylalanine 1 g tablet, 75
AMINO ACID FORMULA WITHOUT PHENYLALANINE (8678R)
8678R
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: 24 | Max qty units: 24 | # of repeats: 5 | DPMQ: $1,170.96 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Phlexy-10 | |||||