AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

amino acid formula with vitamins and minerals without phenylalanine oral liquid, 18 x 250 mL

AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE (8746H)

amino acid formula with vitamins and minerals without phenylalanine oral liquid, 18 x 250 mL
8746H
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: 5 Max qty units: 90 # of repeats: 5 DPMQ: $852.83 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Easiphen