AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
10258XMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid: powder for, 30 x 36 g sachets (PI, CMI)
4 4 5 $868.18 $42.50 $42.50
Available brands
PKU Anamix Junior
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
10410XMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 130 mL pouches (PI, CMI)
4 4 5 $1268.78 $42.50 $42.50
Available brands
PKU Air 15
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
10411YMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouches (PI, CMI)
4 4 5 $1690.98 $42.50 $42.50
Available brands
PKU Air 20
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
12136RMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 28 g sachets (PI, CMI)
4 4 5 $1671.66 $42.50 $42.50
Available brands
PKU Lophlex
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
1909LMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 34 g sachets (PI, CMI)
4 4 5 $1690.98 $42.50 $42.50
Available brands
PKU express 20
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
2382JMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 87 mL pouches (PI, CMI)
4 4 5 $848.30 $42.50 $42.50
Available brands
PKU Cooler 10
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
2474FMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouches (PI, CMI)
4 4 5 $1690.98 $42.50 $42.50
Available brands
PKU Cooler 20
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
2739EMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 500 g (PI, CMI)
8 8 5 $1108.22 $42.50 $42.50
Available brands
XP Maxamum
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
2806QMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral semi-solid, 36 x 109 g tubs (PI, CMI)
3 3 5 $1519.34 $42.50 $42.50
Available brands
PKU Lophlex Sensation 20
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
5483NMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 85 g sachets (PI, CMI)
4 4 5 $867.22 $42.50 $42.50
Available brands
PKU squeezie
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
8555GMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 24 g sachets (PI, CMI)
4 4 5 $867.22 $42.50 $42.50
Available brands
PKU gel
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
8591EMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 25 g sachets (PI, CMI)
4 4 5 $1269.46 $42.50 $42.50
Available brands
PKU express 15
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
8746HMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 18 x 250 mL (PI, CMI)
5 90 5 $1076.02 $42.50 $42.50
Available brands
Easiphen
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
8846NMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 130 mL pouches (PI, CMI)
4 4 5 $1268.78 $42.50 $42.50
Available brands
PKU Cooler 15
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
9021TMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 125 mL pouches (PI, CMI)
4 4 5 $1671.66 $42.50 $42.50
Available brands
PKU Lophlex LQ 20
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
9396MMPNP AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE
amino acid formula with vitamins and minerals without phenylalanine oral liquid, 36 x 125 mL bottles (PI, CMI)
4 4 5 $1040.42 $42.50 $42.50
Available brands
PKU Anamix Junior LQ
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AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE

Source General Schedule
Body System VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
9397NMPNP 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 (PI, CMI)
2 2 5 $867.80 $42.50 $42.50
Available brands
PKU Lophlex LQ 10
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