AMINO ACID SYNTHETIC FORMULA SUPPLEMENTED WITH LONG CHAIN POLYUNSATURATED FATTY ACIDS

amino acid synthetic formula supplemented with long chain polyunsaturated fatty acids powder for oral liquid, 400 g

AMINO ACID SYNTHETIC FORMULA SUPPLEMENTED WITH LONG CHAIN POLYUNSATURATED FATTY ACIDS (9339M)

amino acid synthetic formula supplemented with long chain polyunsaturated fatty acids powder for oral liquid, 400 g
9339M
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Cows' milk protein enteropathy
Treatment phase: Initial treatment for up to 6 months

Restriction

Indication: Severe cows' milk protein enteropathy with failure to thrive
Treatment phase: Initial treatment for up to 6 months

Restriction

Indication: Combined intolerance to cows' milk protein, soy protein and protein hydrolysate formulae
Treatment phase: Initial treatment for up to 6 months

Restriction

Indication: Proven combined immunoglobulin E (IgE) mediated allergy to cows' milk protein and soy protein
Treatment phase: Initial treatment for up to 6 months
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: $236.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
EleCare LCP