GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINE
glycomacropeptide formula with docosahexaenoic acid and low phenylalanine powder for
oral liquid, 30 x 35 g sachets
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: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $1,984.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Sphere20 | |||||