PROTEIN FORMULA WITH AMINO ACIDS, CARBOHYDRATES, VITAMINS AND MINERALS WITHOUT PHENYLALANINE, AND SUPPLEMENTED WITH DOCOSAHEXAENOIC ACID
protein formula with amino acids, carbohydrates, vitamins and minerals without phenylalanine,
and supplemented with docosahexaenoic acid oral liquid, 30 x 130 mL pouches
PROTEIN FORMULA WITH AMINO ACIDS, CARBOHYDRATES, VITAMINS AND MINERALS WITHOUT PHENYLALANINE, AND SUPPLEMENTED WITH DOCOSAHEXAENOIC ACID (10658Y)
10658Y
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: 5 | Max qty units: 5 | # of repeats: 5 | DPMQ: $1,738.98 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Easy | |||||