CSHCN Medical Foods Formulary

Transcription

1 Alimentum AA B4161 See Similac Expert Care, Alimentum Argiment Provides additional nitrogen to promote nitrogen balance during metabolic stress caused by conditions such as pressure sores or illness plus specific amino acids to maintain gut integrity, restore lean body mass and enhance immunity drink mix delivers 4.5 grams of L-arginine and vitamins C and E. Suitable for diabetics or Arginaid calorie-restricted individuals. Arginine See L-arginine designed to combat significant unintended Benecalorie weight loss. 86 cals/27.6 gram packet 25 cals/pkt 330 cals/cup 14 pkts/box 1 pkt=92 gm (0.32 ) 56 packets/case 1 cup = 1.5 fl 24 cups/case Benefiber B4104 Additive for enteral formula (e.g. fiber) see Nutrisource Fiber Beneprotein Boost designed to mix instantly with foods and beverages without compromising taste or texture. For use with individuals who require additional protein to bolster their regular diet to help promote skin health, wound healing, immune response, and muscle strength. a nutritional supplement for between meals, or in place of a meal. Original 25 cals/pkt 1 pkt=7 gm=1 scoop 75 pkts/case 800 cals/8 32 canister servings/cani ster 6 canisters/case 240 cals/brik 27 briks/case Boost Glucose Control B4154 a balance of protein, fat and a slow-digesting carbohydrate that has been clinically shown to help manage blood glucose levels. Glucose Control 250 cals/8 brik 27 briks/case Page 1 of 32 Last Revised 3/15/2012

2 Boost, High Protein Drink Boost Kids Essentials 1.0 Boost Kids Essentials 1.5 with/without Fiber Boost Nutritional Pudding Boost Plus B4160 B4160 B4152 nutritionally complete with proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube. 100% of the Dietary Reference Intakes (DRIs) for protein and 25 key vitamins and minerals 100% of the Dietary Reference Intakes (DRIs) for protein and 25 key vitamins and minerals Delicious, Nutritionally Balanced Pudding more protein than regular BOOST to help fluid restricted patients get the calories they need for healthy weight management combines nutrient density and great taste to address unintentional weight loss and support Med Pass Program success. High Protein Kids Essentials 1.0 Kids Essentials 1.5 Kids Essentials 1.5 w/fiber Nutritional Pudding Boost VHC B4152 Bright Beginnings Infant Formula - All Products B4158 for babies experiencing fussiness or gas Bright Beginnings Soy Pediatric Drink Plus B4159 -Soy Contains a blend of two carbohydrates to maximize absorbtion and minimize any risk of B4159 malabsorption. 240 cals/ brik 237 cals/237 brik 355 cals/ cals/ cals/5 360 cals/240 brik 24 1 lb, 7.4 with iron briks/case 27 briks/case 27 briks/case 27 briks/case 48 cans/case 27 briks/case 530cals/2 37 brik 27 briks/case 240 cals/8 237=8 237=8 237=8 24 = 681 gm 23 = 663 gm = 730 gm Page 2 of 32 Last Revised 3/15/2012

3 Compleat Compleat Pediatric B4149 B4149 Compleat Pediatric, Reduced Calorie, 0.6 cal B4149 Complete Amino Acid Mix Sodium caseinate, chicken, appropriate for Lactose-free and gulten free diets tube feeding formula containing real food available for children ages Designed to improve tolerance. tube feeding formula containing real food available for children ages Designed to improve tolerance. An unflavored, powdered mixture of essential and non-essential amino acids 265 can 1060 cals/ 260 can 150 calories/ calories 200 gm (7. Container) 6 s/case 6 s/case 25 cans/case 2 s/case Crucial B4153 to meet the complex nutritional needs of patients suffering from trauma, major surgery, hypermetabolism, burns, malabsorption, head injury and chronic pressure ulcers. 375 m l can 6 s/case Page 3 of 32 Last Revised 3/15/2012

4 Duocal Elecare Infant Formula - All Products Elecare Junior - All Products Enfagrow Gentlease Formula Enfagrow Premium Toddler Formula Enfagrow Soy Toddler Formula Enfamil A.R. Formula B4161 B4161 B4158 B4158 B4159 B4158 A high-calorie, protein-free, lactose-free, gluten-free powdered food used orally or in tube feedings. Provides fat and carbohydrate for increased caloric intake for children over 1 year old. tolerate milk, soy or protein hydrolysate formulas, Nutritional therapy for severe food allergies, eosinophilic gastrointestinal disorders, short bowel syndrome and EleCare Jr is designed to meet the nutritional needs of children ages 1 year and older who cannot tolerate milk, soy, or protein hydrolysate formulas. nutrition tailored for toddlers, with over 25 nutrients for healthy growth. features 22 nutrients for healthy growth including DHA, prebiotics* and key ingredients that milk lacks. for infants or toddlers months who are transitioning from infant formula or breast milk. Reduces both the frequency and the quantity of spit-up 1968 cals/400 gm 1900 cals/14.1 (400 gm) 1876 cals/400 gm (14.1 ) 3420 cals/24 (681 gm) can 3420 cals/24 (681 gm) can 3220 cals/24 can 80 scoops/contai ner 6 s/case 1 scoop = 9.4 g = 44.6 cal 6 s/case 42 scoops/contai ner 6 s/case 42.5 scoops/contai ner 4 cans/case yields 171 fluid yields 161 fl 4 cans/case 1 scoop=5 gm=25 cals 21.3 cals/100g m. 1 scoop=9.5 gm=44.6 cals 1 scoop=9.4 gm=44.6 cals 4 cans/case 40 cals/2 bottle 48 bottles/case 20 cals/ 640 cals/quart can 6 cans/case 20 cals/ 1820 cals/12.9 yields 91 fl 6 cans/case Page 4 of 32 Last Revised 3/15/2012

5 Enfamil Enfacare Enfamil Gentlease B4160 B4158 Enfamil Lipil B4158 Enfamil Premium Newborn Formula - All Products B4158 designed to support development and growth for premature babies during the first year of life after leaving the hospital 3460 cals/24 can Yields 173 fl 4 cans/case 44 cals/2 bottle 48 bottles/case 22 cals/ 700 cals/quart bottle 6 bottles/case 22 cals/ 1800 cals/12.8 yields 82 fl 6 cans/case 22 cals/ similarity to breast milk has not been proven to 32 (1 result in superior performance in supporting quart) infant development and health. 20 cals/ 6 cans/case bottle 40 cals/2 bottle 48 bottles/case 20 cals/ 640 cals/32 can 6 cans/case 20 cals/ helps enhance baby's development and health during that critical first year. designed to help support brain and eye development, growth and immune system development cals/12 can 3220 cals/22.2 tub 4820 cals/33.2 box yields 87 fl 4 cans/case yields 161 fl yields 241 fl 4 tubs/case 4 boxes/case 48 cals/2 bottle 48 bottles/case 24 cals/ 40 cals/2 bottle 3400 cals/23.4 tub yields 170 fl 4 tubs/case 20 cals/ yields 170 fl 4 tubs/case 2 bottle Page 5 of 32 Last Revised 3/15/2012

6 Enfamil Premium Infant Formula - All Products B4158 designed to help support brain and eye development, growth and immune system development. 40 cals/2 bottle 6 2 bottles/carton; 8 cartons/case 20 cals/ Concentrate Concentrate Enfamil Prosobee B4159 Designed for babies that need a soy formula 120 cals/6 bottle 24 bottles/case 20 cals/ 160 cals/8 bottle 4 boxes/case 20 cals/ 640 cals/32 can 6 cans/case 20 cals/ 320 cals/8 bottle 16 fl 4 boxes/case 40 cals/ 520 cals/13 can 26 fl 12 cans/case 40 cals/ 1800 cals/ fl 6 cans/case 3340 cals/23.4 yields 167 fl tub 6 tubs/case 5000 cals/35 box yields 250 fl 4 boxes/carton 40 cals/2 bottle 48 bottles/case 20 cals/ 120 cals/6 bottle 20 cals/ 160 cals/8 bottle 4 boxes/case 20 cals/ 640 cals/32 can 6 cans/case 20 cals/ Page 6 of 32 Last Revised 3/15/2012

7 Enfaport B4160 designed to meet the unique nutritional needs of infants with Chylothorax or LCHAD deficiency. Concentrate Concentrate 320 cals/8 16 fl 4 boxes/case 40 cals/ 520 cals/13 can 26 fl 12 cans/case 40 cals/ 1840 cals/12.9 yields 92 fl 6 cans/case 3660 cals/25.7 yields 183 fl 6 cans/case 240 cals/8 EO28 Splash, any flavor B4161 Hypoallergenic 240 cals/8 brik 27 briks/case Ensure a source of complete, balanced nutrition for supplemental use with or between meals. 250 cals/8 Ensure Bone Health Targeted nutrition to help build strong bones. 220 cals/8 16 cans/case Ensure Clinical Strength B4152 Gluten-free; suitable for lactose intolerance 350 cals/8 Ensure Enlive B4102 Ensure High Protein Enlive! is a high calorie, fat-free alternative to sweeter-tasting creamy supplements patients who are at nutritional risk, experiencing involuntary weight loss, recovering from illness, injury and surgery, or Liquid 200 cals/ cals/8 bottle 4 per tetra pack, 32 tetra pacls per case 24 bottles/case Page 7 of 32 Last Revised 3/15/2012

8 Ensure Immune Health a unique blend of prebiotic fiber to help promote digestive tract health and antioxidants to support immune system. 250 cals/8 Ensure Muscle Health an excellent source of protein to help rebuild muscle and strength naturally lost over time. 250 cals/8 Ensure Plus B4152 Excellent source to support heart health which has 24 essential vitamins and minerals 350 cals/ cals/32 bottle 6 bottles/case Ensure Ensure Pudding a source of complete, balanced nutrition including 24 essential vitamins and minerals. provides complete, balanced nutrition in a delicious, easy-to-eat form for anyone wanting extra nutrition Makes 7 cals/14 servings of 250 cals/8 6 s/case 170 cals/ packs 48 s/case 7 1/2 cup servings/c ontainer Essential Amino Acid Mix Gerber Good Start, Gentle Formula B4158 mixture of essential amino acids, including cystine and histidine to be mixed with other foods or drink. milk-based infant formulas that creates COMFORT PROTEINS by breaking down the gentle whey protein ingredient into smaller pieces to be easy to digest. Concentrate 2 s/case 7 (200 gm) 60 cals/3 fl (88.7 ) 8 per case 20 cals/ 168 cals/8.45 fl (250 ) 6 per case 20 cals/ 480 cals/12 brik 40 cals/ Page 8 of 32 Last Revised 3/15/2012

9 Gerber Good Start, Gentle 2 Gerber Good Start, Protect formula Gerber Good Start, Protect 2 B4158 B4158 B4158 specially designed to be a nutritious alternative to standard formulas and whole cow s milk. with BIFIDUS BL beneficial cultures like those found in breastmilk to help support Baby's healthy immune system. A milk-based formula for babies 9 to 24 months old, it s specially designed to be a nutritious alternative to standard formulas and whole cow s milk cals/12.7 (360 gm) cals/23.2 (623 gm) 2768 calories per 22 (623 gm) 1600 calories per 12.4 (351 gm) 3020 calories per 23.2 (657 gm) 2800 calories per 22 (623 gm) 40 scoops makes 80 fl. 1 scoop 8.9gm 20 cals/ 74 scoops makes 148 fl. 1 scoop= 8.9 gm. 20 cals/ 69 scoops makes 138 fl. 1 scoop= 9 gm 40 scoops makes 80 fl. 1 scoop= 8.7 gm 75 scoops makes 151 fl. 1 scoop= 8.7 gm 70 scoops makes 140 fl. 1 scoop= 8.8 gm 20 cals/ 20 cals/ 20 cals/ 20 cals/ Page 9 of 32 Last Revised 3/15/2012

10 Gerber Good Start, Soy formula B4159 Milk-free, lactose-free formula for babies 0 to 12 months. Concentrate 60 calories/ 3 fl (88.7 ) 8 per case 20 cals/ 168 cals/8.45 fl (250 ) 4 per case 484 cals/12.1 fl (358 ) 40 cals/ Gerber Good Start, Soy 2 Glucerna 1.0 Cal B4159 B4154 Milk-free, lactose-free formula for your older baby and young toddler For patients with type 1 and type 2 diabetes, with abnormal glucose tolerance resulting from metabolic stress, with mental or total nutrition, for tube feeding 3040 cals/24 (680 gm) 3040 calories per 24 (680 gm) 237 cals/8 76 scoops makes 152 fl, 1 scoop= 8.9 gm 20 cals/ 76 scoops makes 152 fl. 1 scoop = 8.9 gm 20 cals/ 24 (681 gm) Page 10 of 32 Last Revised 3/15/2012

11 Glucerna 1.2 Cal Glucerna 1.5 Cal B4154 B4154 Glucerna 1.2 Cal is a calorically dense formula with a unique carbohydrate blend for enhanced glycemic control and fish oil to support cardiovascular health Glucerna 1.5 Cal is a calorically dense formula with a unique carbohydrate blend for enhanced glycemic control cals/ 285 cals/ cals/ 356 Cals/8 8 s/case 6 s/case 8 s/case 6 s/case 8 s/case Glucerna Shake Glutasolve Hi Cal B4154 B4152 based on the dietary needs for patients requiring blood glucose control. is the preferred amino acid fuel source for the GI tract and is recognized to play an important role in GI health HI-CAL is a high-calorie oral supplement fortified with vitamins and minerals. HI-CAL is ideal for Med-Pass programs. 220 cals/8 90 cals/22.5 gm pkt 2000 cals/1 liter bottle 4 inner cartons, 14 pkts 8 bottles/case 56 pkts/case Page 11 of 32 Last Revised 3/15/2012

12 Isosource 1.5 Cal B4152 Fiber containing standard nutritional support Isosource HN Jevity 1.0 Cal Jevity 1.2 Cal 100% RDI, with the exception of chloride, in 1400 calories/1165 an isotonic, fiber-fortified, high-nitrogen liquid formula. for patients requiring short- or longterm tube feeding. a high-nitrogen, fiber-fortified liquid formula providing complete, balanced nutrition for patients who may benefit from a moderate increase in protein and caloric density. 375 can bag 2250 cals/ bag 300 can 1200 bag 1800 cals/ bag 250 cals/ cals/ 285 cals/can 6 bags/case 6 bags/case 6 bags/case 6 bags/case 8 s/case 6 s/case Page 12 of 32 Last Revised 3/15/2012

13 Jevity 1.5 Cal B4152 a calorically dense liquid food with a patented fiber blend that provides complete, balanced nutrition. Uses: - For tube feeding 1060 cals/ 355 cals/ cals/ 8 s/case 6 s/case 8 s/case 6 s/case Ketocal - All Products B4154 provides complete or supplemental nutritional support for children over one year of age with intractable epilepsy. 3: cals/11 (300 gm ) 699 cals/100 gm 6 s/case 4:1 4:1 Liquid Vanilla 2160 cals/11 (300 gm ) 237 cal/ cals/100 gm 6 s/case 27 cans/case L-arginine a chemical building block called an amino acid. It is necessary for the body to make proteins. none 500 gm s, 1 lb s, 1 kg s Page 13 of 32 Last Revised 3/15/2012

14 MCT Oil MCT Procal B4162 a dietary supplement that help increase the body's metabolism to burn more fat calories A neutral-tasting powder containing protein, carbohydrate and fat high in medium chain triglycerides cals/1 quart bottle 63 Tb/bottle 6 bottles/case 105 cals/16 gm packet 3150 cals/480 gm tub 30 packets/box 1 Tb= cals Microlipid For Special Dietary Use in Oral Supplements, Foods or in Tube Feeding Formulas 400 cals/3 bottle 6 Tb/bottle 48 bottles/case 1 TB=67.5 cals Monogen a milk protein-based powder, low in fat, and high in medium chain triglycerides (MCT) cals/14 (400 gm) 83 scoops/contai ner 6 s/case 1 scoop=4.8 gm= 20 cals Neocate Infant Formula - All Products B4161 designed for babies with severe cow milk allergy and multiple food protein intolerance (a reaction to many different foods) cals/14 (400 gm) 421 cals/100 gm 3 s/case with DHA and ARA 1684 cals/14 (400 gm) 421 cals/100 gm 4 s/case Neocate Junior - All Products B4161 for children ages 1-10 with severe impairment of the gastrointestinal tract cals/14 (400 gm) 478 cals/100 gm 4 s/case 1 scoop=8.2 gm Page 14 of 32 Last Revised 3/15/2012

15 Prebiotics 1912 cals/14 (400 gm) 478 cals/100 gm 4 s/case Neocate - All Products Neosure Nutramigen B4161 B4161 based on 100% free amino acids, the building blocks of protein, to lower the chance that your child will have an allergic reaction. Nutra One+ see Similac Expert Care, Neosure hypoallergenic formula proven to manage colic fast, often within 48 hours cals/14 (400 gm) 240 cals/2.1 (60 gm) sachet 472 cals/100 gm 3 s/case 15 sachets/box 40 cals/2 bottle 48 bottles/case 20 cals/ 120 cals/6 bottle 24 bottles/case 20 cals/ 160 cals/8 bottle 4 boxes/case 20 cals/ 640 cals/32 can 6 cans/case 20 cals/ Concentrate 320 cals/8 16 fl 4 boxes/case 40 cals/ Nutramigen AA B4161 for infants and toddlers with severe cow's milk protein allergy and/or multiple food protein allergies. Concentrate 520 cals/13 can 26 fl 12 cans/case 40 cals/ 1960 cals/14.1 (400 gm) can 4 cans/case Page 15 of 32 Last Revised 3/15/2012

16 Nutren - All Products Nutren 1.5 Nutren 2.0 Nutren Glytrol Nutren Junior - All Products Nutren Pulmonary B4152 B4152 B4154 B4160 B4154 used for complete or supplemental nutrition support. for short or long-term tube feeding for patients with increased caloric requirements and/or a fluid restriction. for short or long-term tube feeding for patients with very high caloric requirements and/or a severe fluid restriction. to support Glycemic control. Supports lean body mass. for the nutritional needs of children aged 1-9 with a functioning GI tract, for tube feeding or oral use. a liquid formula designed to support lower CO2 production in pulmonary patients. with Enfloro LG6 1.0 w/ & w/out fiber w/ & w/out fiber 1740 cals/12.6 (357 gm) can 250 can 375 cal/250 can bag 500 can 2000 bag 250 can 1000 bag cals/ bag 250 carton 1000 bag 375 can 6 cans/case 6 bags/case 6 bags/case 6 bags/case 4 bags/case 6 bags/case Page 16 of 32 Last Revised 3/15/2012

17 Nutren Replete Elevated protein and vitamin and mineral profile to help meet wound healing requirements Nutrisource Fiber B4104 Additive for enteral formula (e.g. fiber) without fiber with fiber formerly Benefiber bag 250 can 1000 bag 250 can cals/ bag 15 cals/4 gm packet 3 grams fiber/4 gm packet 6 bags/case 6 bags/case 4 bags/case 75 packets/case Optimental B4153 for patients who need dietary management of stress/trauma, Crohn s disease, and malabsorptive conditions requiring elemental diets. 765 cals/7.2 (202 gm) canister 237 cals/ gm fiber/canister 4 canisters/case 8 s/case 51 servings/c ontainer; 1 serving=4 gm=1tb Osmolite 1 Cal Precaution: Not intended for infants under 1 year of age unless specified by a physician 250 cals/8 Page 17 of 32 Last Revised 3/15/2012

18 1000 cals/ 8 s/case 6 s/case Osmolite 1.2 Cal for tube-fed patients who may benefit from increased protein and calories. 285 cals/ cals/ 8 s/case 6 s/case Osmolite 1.5 Cal B4152 See Jevity 1.5 Pediasure - All Products B4160 USAGE: As a nutritionally complete, balanced formula especially designed for oral feeding of children 1 to 10 years of age. May be used as the sole source of nutrition or as a supplement. with and without fiber 355 cals/8 240 cals/8 8 s/case Pediasure All Products B4160 designed to meet the energy requirements of pediatric patients who need more calories in less volume. Enteral 1.0 w/ & w/out fiber 240 cals/8 350 cals/8 Page 18 of 32 Last Revised 3/15/2012

19 1458 bag 8 bags/case Pediasure Peptide - All Products B4161 Pediasure Peptide All Products B4161 Pediasure Sidekicks 0.63 Cal. Pediasure Sidekicks Clear enhances macronutrient delivery through Macro 3 for tolerance. is designed to meet the nutritional and caloric needs of kids who require higher caloric density, have fluid restrictions, and are at risk for malnutrition provides 25 essential vitamins and minerals, 7 grams of protein, and 3 grams of fiber to support their nutrition provides 25 essential vitamins and minerals, 7 grams of protein, and 3 grams of fiber to support their nutrition 237 cals/ s/case 356 cals/8 bottle 24 bottles/case 8 s/case 150 calories/8 fl. (240 ) 24 bottles/case 120 Calories/6.8 fl (200 ) 32 s/case Pepdite Junior, any flavor Peptamen - All Products BUT Bariatric Formula B4161 B4153 Extra vitamins and minerals for malabsorptive conditions Complete Elemental Nutrition. When digestion is a challenge, this peptide-based formula is well-tolerated. AF 240 cals/51 gm packet 250 can 300 can 15 packets/box Page 19 of 32 Last Revised 3/15/2012

20 w/prebio 1200 bag 250 can 1000 bag 6 bags/case 6 bags/case Page 20 of 32 Last Revised 3/15/2012

21 cals/ bag 4 bags/case Peptamen 1.5 Peptamen Junior - All Products Polycose Portagen B4153 B4161 B4158 for patients with fluid restriction, patients who cannot tolerate the volumes necessary to achieve their nutritional goals, or who need to receive their entire feeding in just a few hours. Balanced peptide profile to support nitrogen absorption and growth It is particularly useful in supplying carbohydrate calories for protein - electrolyte-, or fat-restricted diets. a fat blend of 87% Medium Chain Triglycerides, which provides linoleic acid and essential fatty acid. with and without fiber with fiber with Prebio can bag 250 carton 1000 bag 250 carton 250 carton 375 carton bag cals/ cals/1 lb can 58 Tb/ 6 bags/case 24 cartons/case 6 bags/case 24 cartons/case 24 cartons/case 24 cartons/case 6 bags/case 6 s/case yields 70 fl 6 cans/case 1 Tb=6gm= 23 cals Page 21 of 32 Last Revised 3/15/2012

22 Pregetimil - all products B4161 a hypoallergenic formula with MCT oil and was specially designed for babies with absorption problems. 40 cals/2 bottle 48 bottles/case 20 cals/ 2240 cals/1 lb yields 112 fl can 6 cans/case Pro Cal - All Products Pro-Cal is a blend of protein which can be added to a wide variety of food and drink to enhance the energy and protein 100 cals/15 gm sachet 25 sachets/box Promod Liquid Protein Promote with and w/out fiber ProPhree A new variation on an old product. It used to be available in powder form. That was discontinued and now they have a liquid version instead. for patients who need a higher proportion of calories from protein. Nutrition support of infants and toddlers who require extra calories, minerals, and vitamins and/or protein restriction. 100 cals/15 gm sachet 3400 cals/510 gm tub 3200 cals/32 bottle 237 cals/can 1000 cals/ 2040 cals/400 gm (14.1 ) 200 sachets/box 6 bottles/case 8 s/case 6 s/case 6 s/case 100 cals/ Page 22 of 32 Last Revised 3/15/2012

23 Prosobee B4159 for the routine feeding of infants with feeding problems such as fussiness and gas. (see Enfamil Prosobee) ProSource Protein - All Products Pro-Stat - All Products an instantly dispersible supplement for patient who need more protein in their diet. Liquid Plus No Carb an enzyme- hydrolyzed concentrated protein fortified with L-tryptophan Sugar Free cals/7.5 gm packet 1100 cals/9.7 tub 3200 cals/32 bottle 100 cals/ packet 3200 cals/32 bottle 100 cals/pack et 1920 cals/32 brik 60 cals/1 packet 72 cals/1 packet 2129 cals/30 bottle 37 scoops/tub 1 =30 =2 tb 100 packets/box 6 tubs/case single or 4 bottles/case 100 packets/case single or 4 bottles/case 100 packets/case single or 4 bottles/case 100 packets/case 96 packets/case 6 bottles/case 100 cals/ 1 packets 100 cals/ 1 packets 60 cals/ 4 inner cartons, 24 pkts each 887 bottle Page 23 of 32 Last Revised 3/15/2012

24 101 AWC Profile RC 101 cals/1 packet 2986 cals/30 bottle 108 cals/1 packet 3193 cals/30 bottle 86 cals/1 packet 2543 cals/30 bottle 72 cals/1 packet 2129 cals/30 bottle 1 =30 =2 tb 1 =30 =2 tb 1 =30 =2 tb 1 =30 =2 tb 96 packets/case 6 bottles/case 96 packets/case 4 bottles/case 96 packets/case 4 bottles/case 96 packets/case 6 bottles/case 4 inner cartons, 24 pkts each 887 bottle 4 inner cartons, 24 pkts each 887 bottle 4 inner cartons, 24 pkts each 887 bottle 4 inner cartons, 24 pkts each 887 bottle ProViMin for any patient who requires increased protein, minerals, and vitamins; X-linked adrenoleukodystrophy. 468 cals/ tb/can 6 cans/case 150 gm can Pulmocare B4154 formula to help reduce carbon dioxide production, which may be helpful for patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or respiratory failure. 355 cals/8 Page 24 of 32 Last Revised 3/15/2012

25 RCF Concentrate RCF is intended for persons who are unable to tolerate the type or amount of carbohydrate in milk or infant formulas. Liquid 8 s/case 311 cals/13 fluid (384 ) 12 s/case Resource 2.0 B4152 designed for the management of fluid restrictions and elevated nutritional needs. 480 cals/8 brik 27 briks/case Resource Arginaid Extra B4102 helps promote the likelihood of wound healing and helps protect and maintain lean muscle mass 1920 cals/32 brik 250 cals/8 brik 12 briks/case 27 briks/case Resource Breeze B4102 a refreshingly delicious, fruit-flavored, clearliquid nutritional supplement 250 cals/8 brik 27 briks/case Resource Thicken- Up Scandical B4100 B4104 Does not alter taste, flavour or smell - No lumping in the final product - Can be added to hot or cold fluids a taste-free powder that quickly and easily adds 35 calories per tablespoon to your meals 25 cals/6.4 gm packet 9000 cals/8 1 packet=1 tb + 1 1/4 tsp 75 packets/case can 50 tb/can 12 cans/case cals/25 lb box 2520 tb/box 1205 cals/8 can 227 gm/can 6 cans/case 1 tb=15 cals=4.5 gm 1 tb=6.5 gm=34.45 cals Scandishake, any flavor B4152 designed to assist patients who need to gain or maintain weight. 440 cals/3 packet 4 packets/box Page 25 of 32 Last Revised 3/15/2012

26 440 cals/3 packet 24 packets/box Similac Advance with Iron or with Low Iron B4158 Strengthen baby s developing immune system. Has DHA and ARA to help baby s brain and eyes develop. Lactose Free 440 cals/3 packet 430 cals/pack et 430 cals/pack et 430 cals/pack et 36 packets/case 4 packets/box 24 packets/box 36 packets/case 4 inner cartons, 9 pkts each 4 inner cartons, 9 pkts each 160 cals/8 bottle 6 bottles/carton 20 cals/ Concentrate Concentrate 160 cals/8 bottle 12 bottles/case 20 cals/ 640 cals/32 bottle 6 bottles/case 20 cals/ 520 cals/13 can 12 cans/case 40 cals/ 1280 cals/32 can 6 cans/case 40 cals/ 12.4 (351.9 gm) yields 90 fl 6 s/case 40 cals/scoo p 40 cals/scoo p yields 168 fl 6 s/case 1.45 lb (657 gm) Page 26 of 32 Last Revised 3/15/2012

27 cals/scoo p yeilds 247 fl 6 s/case (963 gm) Similac Expert Care, Alimentum Similac Expert Care, Neosure B4161 B4160 easy for sensitive babies to digest, and its protein is broken down into tiny pieces to virtually eliminate allergic reactions in most babies who are allergic to cow s-milk protein. to support muscle development Higher levels of vitamins, minerals, and calories than standard-term formula 160 cals/8 bottle 6 bottles/case 20 cals/ 640 cals/32 bottle 6 bottles/case 20 cals/ 2300 cals/1lb yields 115 fl 1 lb 6 s/case 44 cals/2 bottle 48 bottles/case 22 cals/ 704 cals/32 bottle 6 bottles/case 22 cals/ 1914 cals/ yields 87 fl 6 s/case Similac Go and Grow Similac Go and Grow, Soy Similac Sensitive B4158 B4159 B4158 to help support brain and eye development, also promotes greater absorption of calcium 22 (624.3 gm) 6 s/case A unique blend of two carbohydrates corn syrup and sucrose using two absorptive pathways to help maximize absorption and 120 cals/6 minimize malabsorption risks bottle 24 bottles/case 20 cals/ Easy to digest milk-based formula for fussiness and gas due to lactose sensitivity 20 cals/ 6 bottles/carton 8 bottle cals/ 6 bottles/carton bottle 13 Concentrate 40 cals/ 12 s/case 32 Concentrate 40 cals/ 6 s/case Page 27 of 32 Last Revised 3/15/2012

28 yields 90 fl 6 s/case yields 166 fl yields 243 fl 6 s/case 6 s/case lb (657 gm) (963 gm) Similac Sensitive for Spit Up B4158 DHA and ARA for brain and eye development and complete nutrition for sensitive tummies 160 cals/8 bottle 6 bottles/case 20 cals/ 640 cals/32 bottle 20 cals/ Concentrate Concentrate 520 cals/ cals/ cals/ cals/1.45l b (657 gm) yields 90 fl 6 s/case cals/2.12l b yields 168 fl 6 s/case 40 cals/ 40 cals/ 12.3 (349 gm) (657 gm) Similac Sensitive Isomil Soy Formula - All Products B4159 for infants with feeding problems such as fussiness, gas, and spit-up 160 cals/8 bottle 6 bottles/carton 20 cals/ Page 28 of 32 Last Revised 3/15/2012

29 640 cals/32 bottle 6 bottles/case 20 cals/ Similac Special Care 30 w/iron Similac PM 60/40 Simply Thick B4160 B4154 B4100 First and only 30 Cal/fl ready-to-feed liquid preterm infant formula for delivery of highcalorie, nutrient-dense formula for infants who would benefit from lowered mineral intake, including those with impaired renal function. designed specifically for people who have difficulties swallowing. Concentrate Nectar Consistency Nectar Consistency Honey Consistency 520 cals/ cans/case 40 cals/ 1800 cals/ (351.9 (351.9 gm) gm) yields 90 fl 6 s/case 3340 cals/1.45l b (657 gm) 4920 cals/2.12l b (963 gm) yields 167 fl yields 246 fl 6 s/case 6 s/case 1.45 lb (657 gm) 2.12 lb (963 gm) 60 cals/2 bottle 2 bottles 8 bottles/carton 30 cals/ 14.1 yields 102 fl (400 gm) 6 s/case no calories in this product no calories in this product no calories in this product 15 gm packet thickens 4 water 120 gm packet thickens 32 of water 30 gm packet thickens 4 of water 80 packets/case or 200 packets/case 15 packets/case or 80 packets/case 50 packets/case or 100 packets/case Page 29 of 32 Last Revised 3/15/2012

30 Honey Consistency Suplena B4154 is low-protein, therapeutic nutrition designed specifically for patients with reduced kidney function. Super Soluble Duocal See Duocal see Duocal Thicken Up B4100 See Resource Thicken Up food thickener that revolutionized dysphagia care for patients with dysphagia and Thickit B4100 swallowing problems. see Resource Thicken Up calories in this product 425 cals/8 bottle 15 cals/table spoon packet thickens 32 of water 10 packets/case or 40 packets/case 24 bottles/case 240 cals/8 ounce can 12 cans/case Thick & Clear Instant Food Thickner B4100 Odorless, Colorless and Tasteless. Recommended for people with swallowing difficulties. 900 cals/30 ounce can 20 cals/5 gram packet 6 cans/case 200 packets/case 908 cals/8 (227 gm) can cals/10 lb can 12 cans/case Tolerex B4153 for the nutritional management of patients with impaired digestion and absorption. Appropriate for oral or tube feeding use. 300 cals/2.82 packet 60 packets/case 10 inner cartons Page 30 of 32 Last Revised 3/15/2012

31 Two Cal HN Vital - All Products B4152 B4153 designed to meet the increased protein and calorie needs of stressed patients and those requiring low-volume feedings. formula for patients experiencing malabsorption, maldigestion, or impaired GI function and/or feeding intolerance. 1.0 Cal 475 cals/8 237 cals/ s/case 8 s/case 1.5 Cal 355 cals/8 8 s/case Vivonex Pediatric B4161 a nutritionally complete elemental (100% free amino acids) formula designed specifically for children ages Can be used as a tube feeding or consumed orally. AF 1.2 Cal HN 284 cals/ cals/2.79 (79 gm) packet 200 cals/1.7 packet 8 s/case 6 packets/carton 36 packets/case 6 inner cartons Page 31 of 32 Last Revised 3/15/2012

32 Vivonex Plus Vivonex Vivonex T.E.N. B4153 B4153 B4153 a nutritionally complete, elemental diet high in glutamine, that helps improve protein retention. a ready-to-use, high-nitrogen, low-fat, elemental (100% free amino acids) diet for total enteral nutrition. Useful in stressed, catabolic patients. A very low fat, nutritionally complete elemental diet for formulated especially for people with digestive problems. 300 cals/2.82 packet 250 can 1000 cals/ 300 cals/2.84 packet 36 packets/case 6 s/case 6 s/case 60 packets/case 6 inner cartons Page 32 of 32 Last Revised 3/15/2012