Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

Restricted Benefit

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
10375CMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula oral liquid, 8 x 500 mL pouches (PI, CMI)	8	8	5	$718.14	$42.50	$42.50
	Available brands
	Nutrini Peptisorb