SOY PROTEIN AND FAT FORMULA WITH VITAMINS AND MINERALS CARBOHYDRATE FREE

soy protein and fat formula with vitamins and minerals carbohydrate free oral liquid, 384 mL can
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ketogenic diet
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 120 Max qty units: 120 # of repeats: 5 DPMQ: $553.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
RCF