WIC Eligible Formulas
Osmolite 1.0 cal Medical Food Inadequate oral intake with high protein need Pediasure Medical Food Inadequate oral intake in children 1-10 years old Pediasure with Fiber Medical Food Inadequate oral intake in children 1-10 years old with increased fiber need Pediasure Enteral
Download WIC Eligible Formulas
Information
Domain:
Source:
Link to this page:
Related documents
Enteral Nutrition Price List - B4149-B4155 - Minnesota
mn.govApr 15, 2021 · b4150 nu osmolite 1.0 $1.28 $1.27 $1.28 $1.38 b4150 nu osmolite 1.2 $0.65 $1.44 $1.53 $1.49 b4150 nu promote $1.60 $1.68 $1.79 $1.76 b4150 nu promote with fiber $1.64 $1.27 $1.64 $1.64 b4150 nu replete $1.61 $1.69 1.80 $1.80 b4150 nu replete with fiber $1.13 $3.82 1.04 $1.85 hcpcs code mod product name reimb ...
Abbott Nutrition Product Conversion Chart
www.educationandstaffdevelopment.comImpact® Peptide 1.5 Pivot® 1.5 Cal Isosource® 1.5 Cal Jevity® 1.5 Cal Novasource® Renal Nepro® with CarbSteady® Nutren Junior® Fiber PediaSure® Enteral Formula 1.0 Cal With Fiber Isosource® HN Osmolite® 1 Cal Nutren® 2.0 TwoCal® HN Nutren® Pulmonary Pulmocare® Peptamen AF® Vital AF 1.2 Cal® Peptamen Junior® PediaSure® Peptide ...
Product Category: Adult - Abbott Nutrition
static.abbottnutrition.comOsmolite Osmolite 1.0 Cal 2VPROLWH 1.2 Cal ... l Provides 1 serving of organic whole grains per liter. † lProvides an excellent source of plant-based protein from soy and organic rice. lExcellent source of plant-based omega-3 ALA for heart health.‡
Medi-Cal Rx List of Covered Enteral Nutrition Products ...
medi-calrx.dhcs.ca.gov1-800-227-5767 OSMOLITE 1.5 CAL 1L READY TO HANG For patients requiring less than 2000 calories per day or increased protein requirements; AND documentation showing patient is not maintained on a lower kcal/g or ml product 1.50 0.06 70074062700 070074627007 070074626994 0.0059 0.0075 January 1, 2021 Updated MAC and EAC amounts