Product Details
KetoVie 4:1
Nutritional Product1.44 Kcal/mL
Liquid
250-mL Pack (Vanilla Flavour)
DIN/PIN/NPN
09858118
Manufacturer
Ajinomoto Cambrooke, Inc.
Formulary Listing Date
2020-06-30
Unit Price
NA
Amount MOH Pays
6.5451
Coverage Status
Nutrition Product