TRIGLYCERIDES MEDIUM CHAIN FORMULA

triglycerides medium chain formula powder for oral liquid, 400 g

TRIGLYCERIDES MEDIUM CHAIN FORMULA (10152H)

triglycerides medium chain formula powder for oral liquid, 400 g
10152H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Dietary management of conditions requiring a source of medium chain triglycerides
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: $404.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Monogen