DIN/PIN/NPN Detail
96:00 MISCELLANEOUS
96:01:00 NUTRITION PRODUCTS
KetoVie 4:1
(NUTRITIONAL PRODUCT)
1.44kcal/mL Liq-Vanilla Flavour, 250mL Pk
DIN/PIN/NPN:
09858118
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Interchangeables:
NO
Manufacturer:
Ajinomoto Cambrooke, Inc.
Formulary Listing Date:
2020-06-30
Drug Benefit Price or Unit Price:
N/A
Amount MOH Pays:
6.5451
Coverage Status:
Nutrition Product
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