DIN/PIN/NPN Detail

96:00 MISCELLANEOUS

96:01:00 NUTRITION PRODUCTS

KetoVie Peptide 4:1 (NUTRITIONAL PRODUCT)1.49kcal/mL Liq-250mL Pk

DIN/PIN/NPN:09858139

Interchangeables:

NO

Manufacturer:

Ajinomoto Cambrooke, Inc.

Formulary Listing Date:

2021-11-30

Drug Benefit Price or Unit Price:

N/A

Amount MOH Pays:

9.2448

Coverage Status:

Nutrition Product