AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 60
x 62.5 mL pouches
AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE (9397N)
9397N
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: 2 | Max qty units: 2 | # of repeats: 5 | DPMQ: $681.02 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Lophlex LQ 10 | |||||