Product Details
KetoVie 4:1
Nutritional Product1.56 Kcal/mL
Liquid
250-mL Pack (Chocolate Flavour)
DIN/PIN/NPN
09858117
Manufacturer
Ajinomoto Cambrooke, Inc.
Formulary Listing Date
2020-06-30
Unit Price
NA
Amount MOH Pays
6.5451
Coverage Status
Nutrition Product