AMINO ACID FORMULA WITH VITAMINS AND MINERALS, LOW PHENYLALANINE AND SUPPLEMENTED WITH DOCOSAHEXAENOIC ACID AND ARACHIDONIC ACID
amino acid formula with vitamins and minerals, low phenylalanine and supplemented
with docosahexaenoic acid and arachidonic acid powder for oral liquid, 30 x 12.5 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: 8 | Max qty units: 8 | # of repeats: 5 | DPMQ: $958.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Anamix First Spoon | |||||
amino acid formula with vitamins and minerals, low phenylalanine and supplemented
with docosahexaenoic acid and arachidonic acid powder for oral liquid, 30 x 25 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: $958.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Explore 10 | |||||
amino acid formula with vitamins and minerals, low phenylalanine and supplemented
with docosahexaenoic acid and arachidonic acid powder for oral liquid, 30 x 12.5 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: 8 | Max qty units: 8 | # of repeats: 5 | DPMQ: $958.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Explore 5 | |||||