Description:
A low phenylalanine GMP-based powdered medical food complete with vitamins and minerals for the dietary management of Phenylketonuria
Ingredients:
Glycomacropeptide, calcium lactate, L-arginine, L-leucine, L-tyrosine, soy lecithin, glycine, L-lysine acetate, less than 2% of vitamin A palmitate, thiamin mononitrate, riboflavin, pyridoxine hydrochloride, L-tryptophan, L-histidine, DHA algal oil, inulin, sunflower oil, canola oil, d-calcium pantothenate, niacinamide, phytonadione, menaquinone-7, folic acid, biotin, cyanocobalamin, ascorbic acid, cholecalciferol, dl-alpha-tocopheryl acetate, potassium phosphate, magnesium phosphate, ferrous fumarate, maltodextrin, zinc sulfate, manganese sulfate, copper gluconate, potassium iodide, sodium selenite, sodium molybdate, chromium chloride, potassium chloride, salt, Bacillus coagulans GBI-30 6086. Contains milk and soy.
Storage And Use:
Store in a cool, dry place.
Serving:
15 grams/0.5 oz, single-serve stick-pack
Preparation:
Add to 6-12 oz (180-360 mL) of beverage or formula, or add to food. Mix well.
Indications:
For patients age 1 and over with diagnosed phenylketonuria (PKU).
Reimbursement Code:
24359-0353-07
HCPCS: B4157 or B4162
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