Nestlé HealthCare Nutrition Cross Reference Institutional and Retail s (Excluding Devices, Foods, Optisource and Optifast ) TUBE FEEDING FORMULAS COMPLEAT Unflavored 24 x 250 ml Tetra Prisma 043900140100 10043900140107 00212140151 14010000 ml 043900141800 10043900141807 00212141814 43900014180 14180100 SpikeRight PLUS UltraPak 4 x 1500 ml 043900141824 10043900141838 00212182414 43900014182 4390014183 COMPLEAT PEDIATRIC Unflavored 24 x 250 ml Tetra Prisma 043900142401 10043900142408 00212142451 14240000 COMPLEAT PEDIATRIC REDUCED CALORIE- New Unflavored 24 x 250 ml Tetra Prisma 043900380742 10043900380749 43900038074 4390038074 CRUCIAL - Will be discontinued, Replaced by IMPACT PEPTIDE 1.5 Unflavored 24 x 250 ml cans 798716062800 00798716162807 0065912470 9871616280 UltraPak with SpikeRight port 6 x 1000 ml 798716162838 10798716262849 00212628461 98716016283 9871626284 DIABETISOURCE AC Unflavored 24 x 250 ml cans 043900365008 10043900365005 00212365051 36500000 SpikeRight port 6 x 1000 ml 043900365084 10043900365081 00212365014 43900036508 36508100 SpikeRight port 6 x 1500 ml 043900365824 10043900365821 00212365814 43900036582 36582000 FIBERSOURCE HN Unflavored 24 x 250 ml Tetra Prisma 043900185552 10043900185504 00212185551 18550000 ml 043900185880 10043900185887 00212185814 43900018588 18580100 B4149 B4149 B4149 (pending)
SpikeRight PLUS UltraPak 4 x 1500 ml 043900185828 10043900185832 00212185214 43900018582 4390018583 IMPACT Unflavored 24 x 250 ml cans 043900358109 10043900358106 00212358151 35810000 SpikeRight port 6 x 1000 ml 043900358185 10043900358182 00212358114 43900035818 35810800 IMPACT 1.5 - Will be discontinued, Replaced by IMPACT PEPTIDE 1.5 Unflavored 24 x 250 ml 043900358901 10043900358908 00212358951 35890000 IMPACT with FIBER Unflavored 24 x 250 ml cans 043900358703 10043900358700 00212358751 35870000 SpikeRight port 6 x 1000 ml 043900230511 10043900230518 00212358814 43900023051 35880100 IMPACT GLUTAMINE Unflavored 24 x 250 ml Tetra Prisma 043900162102 10043900162109 00212162151 16210000 ml 043900162881 10043900162888 00212162814 43900016288 16280100 IMPACT PEPTIDE 1.5 Unflavored 24 x 250 ml Tetra Prisma 043900973999 10043900974009 43900097399 4390097400 ml 043900973708 10043900973712 43900097370 4390097371 ISOSOURCE 1.5 CAL Vanilla 24 x 250 ml cans 043900181509 10043900181506 00212181551 18150000 SpikeRight port 6 x 1000 ml 043900181813 10043900181810 00212181814 43900018181 18180100 SpikeRight port 6 x 1500 ml 043900181820 10043900181827 00212182014 43900018182 18182000 ISOSOURCE HN Unflavored 24 x 250 ml cans 043900184579 10043900184507 00212184551 18450000
SpikeRight port 6 x 1000 ml 043900184807 10043900184804 00212184814 43900018480 18480100 SpikeRight port 6 x 1500 ml 043900184661 10043900184668 00212846214 43900018466 18462800 NOVASOURCE RENAL Vanilla 27 x 8 fl oz Tetra Brik 043900351117 10043900351107 00212351162 35110000 SpikeRight port 6 x 1000 ml 043900351803 10043900351800 00212351814 43900035180 35180100 NUTREN 1.0 Vanilla 24 x 250 ml Tetra Prisma 798716062107 00798716162104 0065902470 9871616210 NUTREN 1.0 FIBER Vanilla 24 x 250 ml Tetra Prisma 798716060561 00798716160568 0065902570 9871616056 NUTREN 1.5 Vanilla 24 x 250 ml Tetra Prisma 798716062206 00798716162203 0065903270 9871616220 ml 798716163545 10798716263549 00212120414 98716016354 9871626354 NUTREN 2.0 Vanilla 24 x 250 ml Tetra Prisma 798716062305 00798716162302 0065904070 9871616230 ml 798716331470 00798716441469 00212414661 98716033147 9871644146 NUTREN GLYTROL Vanilla 24 x 250 ml cans 798716062756 00798716162753 0065908570 9871616275 UltraPak with SpikeRight port 6 x 1000 ml 798716163767 10798716223901 00212239061 98716016376 9871622390 UltraPak with SpikeRight port 4 x 1500 ml 798716163774 00798716323918 00212239161 98716016377 9871632391 NUTREN JUNIOR B4160 Vanilla 24 x 250 ml Tetra Prisma 798716060622 00798716160629 0065904370 9871616062 SpikeRight Plus UltraPak 6 x 1000 ml 798716673709 00798716773805 00212738061 9871677380
NUTREN JUNIOR FIBER Vanilla 24 x 250 ml Tetra Prisma 798716060639 00798716160636 0065904570 9871616063 SpikeRight Plus UltraPak 6 x 1000 ml 798716673907 00798716774000 00212741061 9871677400 NUTREN PULMONARY Vanilla 24 x 250 ml Tetra Prisma 798716064804 00798716164801 0065914170 9871616480 ml 798716163620 10798716223925 00212239261 98716016362 9871622392 NUTREN REPLETE - Will be replaced by REPLETE Vanilla 24 x 250 ml cans 798716062497 00798716162494 0065902270 9871616249 UltraPak with SpikeRight port 6 x 1000 ml 798716163569 10798716263563 00212457914 98716016356 9871626356 NUTREN REPLETE FIBER- Will be replaced by REPLETE FIBER Vanilla 24 x 250 ml cans 798716062459 00798716162456 0065902370 9871616245 UltraPak with SpikeRight port 6 x 1000 ml 798716163583 10798716263587 00212635861 98716016358 9871626358 UltraPak with SpikeRight port 4 x 1500 ml 798716163590 10798716263594 00212635961 98716016359 9871626359 NUTRIHEP Unflavored 24 x 250 ml cans 798716064798 00798716164795 0065907870 9871616479 PEPTAMEN Unflavored 24 x 250 ml Tetra Prisma 798716062695 00798716162692 0065901470 9871616269 Vanilla 24 x 250 ml Tetra Prisma 798716062602 00798716162609 0065906770 9871616260 PEPTAMEN 1.5 Unflavored 24 x 250 ml Tetra Prisma 798716081924 00798716181921 0065908870 9871618192 B4160 Vanilla 24 x 250 ml Tetra Prisma 798716081900 00798716181907 0065908770 9871618190 ml 798716181945 10798716281949 00212819461 98716018194 9871628194
PEPTAMEN 1.5 with PREBIO 1TM - New Vanilla 24 x 250 ml Tetra Prisma 043900349589 10043900349586 43900034958 4390034958 ml 043900349572 10043900349579 43900034957 4390034957 PEPTAMEN AF Unflavored 24 x 250 ml Tetra Prisma 798716663601 00798716663700 0065909271 9871666370 ml 798716663809 00798716763905 00212639061 98716066380 9871676390 PEPTAMEN BARIATRIC Unflavored 24 x 250 ml Tetra Prisma 043900972343 10043900972357 43900097234 4390097235 ml 043900972664 10043900972678 43900097266 4390097267 PEPTAMEN with PREBIO 1TM Vanilla 24 x 250 ml Tetra Prisma 798716181853 10798716181850 0065907670 9871618185 ml 798716128049 10798716228043 00212280461 98716012804 9871622804 SpikeRight PLUS UltraPak 4 x 1500 ml 798716128056 10798716228050 00212280561 98716012805 9871622805 PEPTAMEN JUNIOR B4161 Vanilla 24 x 250 ml Tetra Prisma 798716062527 00798716162524 0065907070 9871616252 Chocolate 24 x 250 ml Tetra Prisma 798716601108 00798716601207 0065907071 9871660120 Strawberry 24 x 250 ml Tetra Prisma 798716601405 00798716601306 0065907072 9871660130 Unflavored 24 x 250 ml Tetra Prisma 798716062534 00798716162531 0065906970 9871616253 SpikeRight Plus UltraPak 6 x 1000 ml 798716673501 00798716773607 00212740061 98716067350 9871677360 PEPTAMEN JUNIOR 1.5 Unflavored 24 x 250 ml Tetra Prisma 798716073639 00798716173636 00212847315 98716007363 9871617363 B4161
SpikeRight Plus UltraPak 6 x 1000 ml 798716085434 00798716185431 00212841515 98716008543 9871618543 PEPTAMEN JUNIOR FIBER Vanilla 24 x 250 ml Tetra Prisma 798716602006 00798716602105 0065906871 9871660210 PEPTAMEN JUNIOR with PREBIO 1 Vanilla 24 x 250 ml Tetra Prisma 798716162616 10798716162613 0065906870 9871616261 RENALCAL Unflavored 24 x 250 ml Tetra Prisma 798716060646 00798716160643 0065901370 9871616064 REPLETE Vanilla 24 x 250 ml Tetra Prisma 798716062497 00798716162494 0065902270 9871616249 ml 798716163569 10798716263563 00212457914 98716016356 9871626356 REPLETE FIBER Vanilla 24 x 250 ml Tetra Prisma 798716062459 00798716162456 0065902370 9871616245 ml 798716163583 10798716263587 00212635861 98716016358 9871626358 SpikeRight PLUS UltraPak 4 x 1500 ml 798716163590 10798716263594 00212635961 98716016359 9871626359 TOLEREX 60 x 2.82 oz (80 g) pkts 043900458069 10043900458059 00212458072 04580500 VIVONEX PEDIATRIC Unflavored 36 x 48.5 g (1.7 oz) pkts 043900713199 10043900713103 00212713176 07131000 VIVONEX PLUS Unflavored 36 x 2.8 oz (79 g) pkts 043900712994 10043900712984 00212729818 07129800 VIVONEX RTF Unflavored 24 x 250 ml Tetra Prisma 043900362502 10043900362509 00212362551 36250000 B4161 B4161 B4161
ml 043900362809 10043900362806 00212362814 43900036280 36280100 SpikeRight PLUS UltraPak 4 x 1500 ml 043900362823 10043900362837 00212628214 43900036282 4390036283 VIVONEX T.E.N. Unflavored 60 x 80.4 g (2.84 oz) pkts 043900712741 10043900712748 00212727873 07127400 ORAL SUPPLEMENTS ARGINAID Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 00212598375 35983000 Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 00212598475 35984000 BENECALORIE 24-1.5 fl oz cups/case 043900282503 10043900282500 00212282580 28250000 BENEPROTEIN Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 28430000 Powder 6 x 8 fl oz 043900284101 10043900284108 00212284107 28410000 BOOST (bottle) (INSTITUTIONAL)- Former Vanilla 24 x 237 ml bottle 043900674391 00043900674308 00212674313 43900067439 06743900 Chocolate 24 x 237 ml bottle 043900675398 00043900675305 00212675313 43900067539 06753900 Strawberry 24 x 237 ml bottle 043900676388 00043900676302 00212067613 43900067638 06763800 BOOST (INSTITUTIONAL)- New Case Count, UPC and s Vanilla 27 x 237 ml Tetra Brik 043900674391 10043900674381 00212674313 43900067439 4390067438 Chocolate 27 x 237 ml Tetra Brik 043900675398 10043900675388 00212675313 43900067539 4390067538 Strawberry 27 x 237 ml Tetra Brik 043900676388 10043900676392 00212067613 43900067638 4390067639 BOOST (RETAIL) Vanilla 24 (4x6 Pk) x 237 ml bottle 041679674000 00041679674369 41679067466 06743600 Chocolate 24 (4x6 Pk) x 237 ml bottle 041679675007 00041679675366 41679067566 06753600
Strawberry 24 (4x6 Pk) x 237 ml bottle 041679676004 00041679676363 41679067666 06763600 BOOST GLUCOSE CONTROL (INSTITUTIONAL) Vanilla 27 x 8 fl oz 043900360119 10043900360109 00212360162 36010000 Strawberry 27 x 8 fl oz 043900360317 10043900360307 00212360362 36030000 Chocolate 27 x 8 fl oz 043900360218 10043900360208 00212360262 36020000 BOOST GLUCOSE CONTROL (RETAIL) Vanilla 24 (4x6 Pk) x 237 ml bottle 041679157824 00041679157800 41679015781 15780000 Chocolate 24 (4x6 Pk) x 237 ml bottle 041679157923 00041679157909 41679015791 15790000 Strawberry 24 (4x6 Pk) x 237 ml bottle 041679158111 00041679158104 41679015812 15810000 BOOST HIGH PROTEIN (bottle) (INSTITUTIONAL)- Former Vanilla 24 x 237 ml bottle 043900941394 00043900941301 00212941313 43900094139 09413900 BOOST HIGH PROTEIN (bottle) (INSTITUTIONAL)-New Case Count, UPC and s Vanilla 27 x 237 ml Tetra Brik 043900941394 100-43900-94139-1 00212941313 43900094139 4390094139 BOOST HIGH PROTEIN (bottle) (RETAIL) Vanilla 24 (4x6 Pk) x 237 ml bottle 041679941003 00041679941362 41679094166 09413600 Chocolate 24 (4x6 Pk) x 237 ml bottle 041679940006 00041679940365 41679094066 09403600 Strawberry 24 (4x6 Pk) x 237 ml bottle 041679944004 00041679944363 41679094466 09443600 BOOST KID ESSENTIALS (INSTITUTIONAL) Vanilla 27 x 237 ml Tetra Brik 043900335117 10043900335114 00212335113 43900033511 33510000 Chocolate 27 x 237 ml Tetra Brik 043900335209 10043900335220 00212335213 43900033520 33520000 Strawberry 27 x 237 ml Tetra Brik 043900335308 10043900335336 00212335313 43900033530 33530000 BOOST KID ESSENTIALS (RETAIL) Vanilla 16 (4x4 Pk) x 244 ml 041679332511 041679339688 00212332513 41679033251 12126200 Chocolate 16 (4x4 Pk) x 244 ml 041679332610 041679339787 00212332613 41679033261 12126189 BOOST KID ESSENTIALS 1.5 (INSTITUTIONAL) Vanilla 27 x 237 ml Tetra Brik 043900335407 10043900335442 00212335413 43900033540 33540000 Strawberry 27 x 237 ml Tetra Brik 043900335902 10043900335992 00212335913 43900033590 33590000 B4160 B4160 B4160
Chocolate 27 x 237 ml Tetra Brik 043900335889 10043900335886 00212335813 43900033588 33580000 With Fiber, Vanilla 27 x 237 ml Tetra Brik 043900335001 10043900335008 00212335013 43900033500 33500000 BOOST PLUS (bottle) (INSTITUTIONAL)- Former Vanilla 24 x 237 ml bottle 043900931395 00043900931302 00212931313 43900093139 09313900 Strawberry 24 x 237 ml bottle 043900933382 00043900933306 00212933313 43900093338 09333800 Chocolate 24 x 237 ml bottle 043900932392 00043900932309 00212932313 43900093239 09323900 BOOST PLUS (INSTITUTIONAL)- New Case Count, UPC and s Vanilla 27 x 237 ml Tetra Brik 043900931395 10043900931385 00212931313 43900093139 4390093138 Chocolate 27 x 237 ml Tetra Brik 043900932392 10043900932382 00212932313 43900093239 4390093238 Strawberry 27 x 237 ml Tetra Brik 043900933382 10043900933310 00212933313 43900093338 4390093331 BOOST PLUS (RETAIL) Vanilla 24 (4x6 Pk) x 237 ml bottle 041679931004 00041679931363 41679093166 09313600 Strawberry 24 (4x6 Pk) x 237 ml bottle 041679933008 00041679933367 41679093366 09333600 Chocolate 24 (4x6 Pk) x 237 ml bottle 041679932001 00041679932360 41679093266 09323600 BOOST VHC (INSTITUTIONAL) Vanilla 27 x 237 ml Tetra Brik 043900182155 10043900182169 43900018215 4390018216 CARNATION INSTANT BREAKFAST LACTOSE FREE- Will be discontinued Vanilla Swirl 24 x 250 ml 798716038898 00798716338882 0065905070 9871633888 Chocolate Splash 24 x 250 ml 798716038911 00798716338905 0065905071 9871633890 CARNATION INSTANT BREAKFAST LACTOSE FREE PLUS- Will be discontinued Plus, Vanilla Swirl 24 x 250 ml 798716038959 00798716389402 0065905073 9871638940 Plus, Chocolate Splash 24 x 250 ml 798716038973 00798716338967 0065905074 9871633896 CARNATION INSTANT BREAKFAST LACTOSE FREE VHC- Will be replaced by BOOST VHC VHC, Vanilla 24 x 250 ml 798716039017 00798716339001 0065905076 9871633900 GLUTASOLVE
56 x 22.5 g (0.79 oz) pkts 043900283005 10043900283309 00212283378 28330000 IMPACT ADVANCED RECOVERY Vanilla 15 X 8 fl oz 043900195506 10043900195510 00212195562 19571000 Chocolate 15 X 8 fl oz 043900195605 10043900195619 00212195662 19581000 MCT OIL (Medium Chain Triglycerides) 6 x 1 Qt Amber bottle 041679365038 00041679365137 41679036513 03651300 MICROLIPID 48 x 3 fl oz bottle 041679087435 00041679087022 41679008702 00870200 NUTRAMENT (RETAIL) Vanilla 24 x 12 fl oz cans 041679633120 00041679633014 41679063301 06330100 Chocolate 24 x 12 fl oz cans 041679632123 00041679632017 41679063201 06320100 Strawberry 24 x 12 fl oz cans 041679634127 00041679634011 41679063401 06340100 Coconut 24 x 12 fl oz cans 041679636121 00041679636015 41679063601 06360100 Banana 24 x 12 fl oz cans 041679635124 00041679635018 41679063501 06350100 Egg Nog 24 x 12 fl oz cans 041679637128 00041679637012 41679063701 06370100 Dulce De Leche 24 x 12 fl oz cans 041679603413 00041679603017 41679060301 16030100 NUTRISOURCE FIBER Powder 75 x 0.14 oz pkts 043900976471 10043900976485 43900097647 4390097648 Powder 4 x 7.2 oz Canister 043900975504 10043900975518 43900097550 4390097551 RESOURCE 2.0 Vanilla Creme 27 x 8 fl oz 043900180106 10043900180103 00212180162 18010000 Vanilla Creme 12 x 32 fl oz 043900276007 10043900276004 00212276065 27600000 RESOURCE ARGINAID - Will be replaced by ARGINAID Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 00212598375 35983000 Lemon 56 x 0.32 oz (9 g) pkts 043900359823 10043900359851 00212598575 35985000 Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 00212598475 35984000 RESOURCE ARGINAID EXTRA N/A B4104 B4102
Orange Burst 27 x 8 fl oz 043900196602 10043900196609 00212196662 19660000 Wildberry 27 x 8 fl oz 043900196701 10043900196708 00212196762 19670000 RESOURCE BENECALORIE - Will be replaced by BENECALORIE 24-1.5 fl oz cups/case 043900282503 10043900282500 00212282580 28250000 RESOURCE BENEFIBER - Will be replaced by NUTRISOURCE FIBER Powder 75 x 4 g (0.14 oz) pkts 043900282305 10043900282302 00212282374 28230000 Powder 4 x 7.2 oz (205 g) Canister 043900282107 10043900282104 00212282107 28210000 RESOURCE BENEPROTEIN - Will be replaced by BENEPROTEIN Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 28430000 Powder 6 x 8 fl oz 043900284101 10043900284108 00212284107 28410000 RESOURCE BREEZE Orange 27 x 8 fl oz 043900186290 10043900186204 00212186262 18620000 Peach 27 x 8 fl oz 043900186498 10043900186402 00212186462 18640000 Wild Berry 27 x 8 fl oz 043900186665 10043900186600 00212186662 18660000 Orange- 043900186290 Peach- Variety Case 27 x 8 fl oz 043900186498 10043900186006 00212186062 18600000 Wild Berry- 043900186665 RESOURCE DIABETISHIELD Orange Twist 27 x 8 fl oz 043900349107 10043900349104 00212349162 34910000 Mixed Berry 27 x 8 fl oz 043900349305 10043900349302 00212349362 34930000 RESOURCE GLUTASOLVE - Will be replaced by GLUTASOLVE 56 x 22.5 g (0.79 oz) pkts 043900283005 10043900283309 00212283378 28330000 RESOURCE THICKENUP B4104 B4100 Unflavored 75 x 0.22 oz (6.4 g) pkts/case 043900225418 10043900225408 00212225471 22540000
Unflavored 12 x 8 oz (227 g) cans/case 043900225104 10043900225101 00212225107 22510000 Unflavored 1 x 25 lb (11.34 kg)bag/box 10043900225309 10043900225309 00212225305 22530000 RESOURCE THICKENUP CLEAR (RETAIL)- New 12 x 125 g (4.4 oz) canister/ case 041679151945 00041679151952 41679015194 4617915195 2-pack 4.4 oz (2x6 ct case) canister 041679151945 00041679151976 41679015194 4167915197 Sticks 24 x 12 ct case 041679151921 00041679151938 41679015191 4167915193 RESOURCE THICKENUP CLEAR (INSTITUTIONAL)- New 288 x 1.4 g stick packets/ case 043900151915 10043900151936 43900015191 4390015193 12 x 125 g (4.4 oz) canister/ case 043900151946 10043900151950 43900015194 4390015195 5 Kg 1 ct case na 10043900151981 43900015198 4390015198 Benefiber is the registered trademark of Novartis AG and is used under license. * NDC Format - Since Nestlé no longer prints NDC Format s on product labels, FDB uses the product UPC code to create a number that can be found in the "NDC" field of the FDB publication. Reimbursement information provided by Nestlé HealthCare Nutrition, Inc., (HCN) is gathered from third party sources and is presented for illustrative purposes only. This information does not constitute reimbursement or legal advice and does not constitute a recommendation related to medical necessity or the documentation that should be provided in connection with a given patient or claim. All medical necessity determinations must be made by the responsible clinician. HCN makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability to a particular patient. HCN specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Suppliers are responsible for submitting accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. Accordingly, HCN recommends that you consult with your payers, reimbursement specialist and/or legal counsel regarding coding, coverage and reimbursement matters. Please be advised that certain Nestlé HealthCare Nutrition, Inc., products have been assigned s. s are not actual National Drug s (NDC). s are product codes adjusted according to standard industry practice to meet the format requirements of certain suppliers and payers. Nestlé HealthCare Nutrition submits product information including various product codes to the compendia including, RedBook and Medispan but cannot confirm that the s submitted have been published by the compendia. Except as noted all trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland or are used with permission. (c) 2011 Nestlé Updated 1-18-12 B4100 B4100