Download NDC-format codes have been submitted by Abbott Nutrition to data

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript
Friday, November 15, 2013
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Adult Nutritional
56500
Ensure Clear Ready-to-Drink Blueberry Pomegranate Retail /
10-fl-oz Bottle / Case of 12
None
No Medicare rate
70074-0565-02
70074-0565-01 (4
bottles)
Adult Nutritional
56604
Ensure Clear Ready-to-Drink Peach Retail / 10-fl-oz Bottle /
Case of 12
None
No Medicare rate
70074-0566-06
70074-0566-05 (4
bottles)
Adult Nutritional
56640
Ensure Clear Ready-to-Drink Apple Institutional / 6.7-fl-oz
(198 mL) Brik Pak / Case of 32
B4102
No Medicare rate
70074-0566-41
70074-0566-40
(32 tetras)
Adult Nutritional
56642
Ensure Clear Ready-to-Drink Mixed Berry Institutional / 6.7-fl- B4102
oz (198 mL) Brik Pak / Case of 32
No Medicare rate
70074-0566-43
70074-0566-42
(32 tetras)
Adult Nutritional
50464
Ensure Plus Ready-to-Drink Vanilla Institutional / 8-fl-oz (237- B4152
mL) Can / Case of 24
$0.55
70074-0504-65
Adult Nutritional
50466
Ensure Plus Ready-to-Drink Milk Chocolate Institutional / 8-fl- B4152
oz (237-mL) Can / Case of 24
$0.55
70074-0504-67
Adult Nutritional
50646
Ensure Plus Ready-to-Drink Strawberry Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4152
$0.55
70074-0506-47
Adult Nutritional
51894
Ensure Plus Ready-to-Drink Butter Pecan Institutional / 8-fl-oz B4152
(237-mL) Can / Case of 24
$0.55
70074-0518-95
Adult Nutritional
53809
Ensure Plus Ready-to-Drink Dark Chocolate Retail / 8-fl-oz
Bottle / Case of 24
B4152
$0.55
70074-0538-11
Adult Nutritional
57263
Ensure Plus Ready-to-Drink Vanilla Retail / 8-fl-oz Bottle /
Case of 24
B4152
$0.55
70074-0407-07 (6
bottles)
Adult Nutritional
57266
Ensure Plus Ready-to-Drink Milk Chocolate Retail / 8-fl-oz
Bottle / Case of 24
B4152
$0.55
70074-0407-02 (6
bottles)
Adult Nutritional
57269
Ensure Plus Ready-to-Drink Strawberry Retail / 8-fl-oz Bottle / B4152
Case of 24
$0.55
70074-0407-18 (6
bottles)
Adult Nutritional
57272
Ensure Plus Ready-to-Drink Butter Pecan Retail / 8-fl-oz Bottle B4152
/ Case of 24
$0.55
70074-0517-87 (6
bottles)
Adult Nutritional
58251
Ensure Plus Ready-to-Drink Vanilla Institutional / 32-fl-oz (946- B4152
mL) Bottle / Case of 6
$0.55
70074-0582-52
Adult Nutritional
58299
Ensure Plus Ready-to-Drink Milk Chocolate Institutional / 8-fl- B4152
oz (237-mL) Bottle / Case of 24
$0.55
70074-0583-00
Adult Nutritional
58301
Ensure Plus Ready-to-Drink Strawberry Institutional / 8-fl-oz
(237-mL) Bottle / Case of 24
B4152
$0.55
70074-0583-02
Adult Nutritional
58303
Ensure Plus Ready-to-Drink Vanilla Institutional / 8-fl-oz (237- B4152
mL) Bottle / Case of 24
$0.55
70074-0583-04
Adult Nutritional
53806
Ensure Ready-to-Drink Dark Chocolate Retail / 8-fl-oz Bottle / B4150
Case of 24
$0.68
70074-0538-08
Adult Nutritional
57231
Ensure Ready-to-Drink Milk Chocolate Retail / 8-fl-oz Bottle /
Case of 24
B4150
$0.68
70074-0407-01 (6
bottles)
Adult Nutritional
57234
Ensure Ready-to-Drink Strawberry Retail / 8-fl-oz Bottle /
Case of 24
B4150
$0.68
70074-0407-05 (6
bottles)
Adult Nutritional
57240
Ensure Ready-to-Drink Butter Pecan Retail / 8-fl-oz Bottle /
Case of 24
B4150
$0.68
70074-0517-85 (6
bottles)
Adult Nutritional
57243
Ensure Ready-to-Drink Vanilla Retail / 8-fl-oz Bottle / Case of
24
B4150
$0.68
70074-0407-11 (6
bottles)
Adult Nutritional
53432
Ensure Ready-to-Drink Vanilla Retail CLUB / 8-fl-oz Bottle /
Case of 16
B4150
$0.68
70074-0534-32
(16 bottles)
Adult Nutritional
53623
Ensure Ready-to-Drink Milk Chocolate CLUB / 8-fl-oz Bottle /
Case of 16
B4150
$0.68
70074-0536-23
(16 bottles)
Adult Nutritional
56564
Ensure Complete Ready-to-Frink Vanilla Institutional/ 8 fl-oz
Bottle/ Case of 24
B4152
$0.55
70074-0565-65
70074-0565-64
(24 Bottles)
Adult Nutritional
56562
Ensure Complete Ready-to-Frink Chocolate Institutional/ 8 floz Bottle/ Case of 24
B4152
$0.55
70074-0565-63
70074-0565-62
(24 Bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
Adult Nutritional
62010
Adult Nutritional
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
Ensure Complete Ready-to-Frink Strawberry Institutional/ 8 fl- B4152
oz Bottle/ Case of 24
$0.55
70074-0620-11
70074-0620-10
(24 Bottles)
62761
Ensure Complete Ready-to-Frink Vanilla Retaill/ 8 fl-oz Bottle/ B4152
Case of 24
$0.55
70074-0627-63
70074-0627-62 (4 70074-0627-61
bottles)
(24 Bottles)
Adult Nutritional
62758
Ensure Complete Ready-to-Frink Chocolate Retaill/ 8 fl-oz
Bottle/ Case of 24
B4152
$0.55
70074-0627-60
70074-0627-59 (4 70074-0627-58
bottles)
(24 Bottles)
Adult Nutritional
56488
Ensure Clinical Strength Ready-to-Drink Homemade Vanilla
Retail / 8-fl-oz Bottle/ Case of 16
B4152
$0.55
70074-0564-89 (4
bottles)
Adult Nutritional
56491
Ensure Clinical Strength Ready-to-Drink Creamy Milk
Chocolate Retail / 8-fl-oz Bottle / Case of 16
B4152
$0.55
70074-0564-92 (4
bottles)
Adult Nutritional
56494
Ensure Clinical Strength Ready-to-Drink Strawberries & Cream B4152
Retail / 8-fl-oz Bottle / Case of 16
$0.55
70074-0564-95 (4
bottles)
Adult Nutritional
56562
Ensure Clinical Strength Ready-to-Drink Creamy Milk
Chocolate Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4152
$0.55
70074-0565-63
Adult Nutritional
56564
Ensure Clinical Strength Ready-to-Drink Homemade Vanilla
Institutional/ 8-fl-oz (237-mL) Bottle / Case of 24
B4152
$0.55
70074-0565-65
Adult Nutritional
62010
Ensure Clinical Strength Ready-to-Drink Strawberries & Cream B4152
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
$0.55
70074-0620-11
Adult Nutritional
52098
Ensure High Protein Ready-to-Drink Milk Chocolate
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4150
$0.68
70074-0520-99
Adult Nutritional
52100
Ensure High Protein Ready-to-Drink Vanilla Institutional / 8-fl- B4150
oz (237-mL) Can / Case of 24
$0.68
70074-0521-01
Adult Nutritional
50459
Ensure High Protein SHAKE Ready-to-Drink Homemade Vanilla None
Retail / 14-fl-oz (414-mL) Bottle / Case of 12
No Medicare rate
70074-0504-57
70074-0504-58 (4
bottles)
Adult Nutritional
50515
Ensure High Protein SHAKE Ready-to-Drink Creamy Milk
Chocolate Retail / 14-fl-oz (414-mL) Bottle / Case of 12
No Medicare rate
70074-0504-69
70074-0505-14 (4
bottles)
Adult Nutritional
50460
Ensure Immune Health Ready-to-Drink Vanilla Institutional / 8- B4150
fl-oz (237-mL) Can / Case of 24
$0.68
70074-0504-61
Adult Nutritional
50462
Ensure Immune Health Ready-to-Drink Milk Chocolate
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4150
$0.68
70074-0504-63
Adult Nutritional
50648
Ensure Immune Health Ready-to-Drink Strawberry
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4150
$0.68
70074-0506-49
Adult Nutritional
51892
Ensure Immune Health Ready-to-Drink Butter Pecan
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4150
$0.68
70074-0518-93
Adult Nutritional
56458
Ensure Immune Health Ready-to-Drink Creamy Milk Chocolate B4150
Retail / 8-fl-oz Bottle / Case of 16
$0.68
70074-0564-59 (4
bottles)
Adult Nutritional
56461
Ensure Immune Health Ready-to-Drink Strawberries & Cream B4150
Retail / 8-fl-oz Bottle / Case of 16
$0.68
70074-0564-62 (4
bottles)
Adult Nutritional
56467
Ensure Immune Health Ready-to-Drink Homemade Vanilla
Retail / 8-fl-oz Bottle / Case of 16
B4150
$0.68
70074-0564-68 (4
bottles)
Adult Nutritional
58293
Ensure Immune Health Ready-to-Drink Milk Chocolate
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4150
$0.68
70074-0582-94
Adult Nutritional
58295
Ensure Immune Health Ready-to-Drink Strawberry
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4150
$0.68
70074-0582-96
Adult Nutritional
58297
Ensure Immune Health Ready-to-Drink Vanilla Institutional / 8- B4150
fl-oz (237-mL) Bottle / Case of 24
$0.68
70074-0582-98
Adult Nutritional
56476
Ensure Muscle Health Ready-to-Drink Vanilla Retail / 8-fl-oz
Bottle / Case of 16
B4150
$0.68
70074-0564-77 (4
bottles)
Adult Nutritional
56479
Ensure Muscle Health Ready-to-Drink Milk Chocolate Retail / 8- B4150
fl-oz Bottle / Case of 16
$0.68
70074-0564-80 (4
bottles)
Adult Nutritional
56482
Ensure Muscle Health Ready-to-Drink Strawberry Retail / 8-fl- B4150
oz Bottle / Case of 16
$0.68
70074-0564-83 (4
bottles)
Adult Nutritional
56485
Ensure Muscle Health Ready-to-Drink Banana Cream Retail / 8- B4150
fl-oz Bottle / Case of 16
$0.68
70074-0564-86 (4
bottles)
Adult Nutritional
56558
Ensure Muscle Health Vanilla Institutional / 8-fl-oz (237-mL)
Bottle / Case of 24
$0.68
None
B4150
NDC-Format
NDC-Format
Code for Carton Code for Case
70074-0565-59
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Adult Nutritional
56560
Ensure Muscle Health Milk Chocolate Institutional / 8-fl-oz
(237-mL) Bottle / Case of 24
B4150
$0.68
70074-0565-61
Adult Nutritional
62012
Ensure Muscle Health Strawberry Institutional / 8-fl-oz (237mL) Bottle / Case of 24
B4150
$0.68
70074-0620-13
Adult Nutritional
00750
Ensure Powder Homemade Vanilla / 14-oz (397-g) Can / Case B4150
of 6
$0.68
70074-0607-50
Adult Nutritional
54844
Ensure Pudding Homemade Vanilla / 4-oz (113-g) Plastic Cups None
/ Case of 48
No Medicare rate
70074-0548-45 (4
cups)
Adult Nutritional
54846
Ensure Pudding Creamy Milk Chocolate / 4-oz (113-g) Plastic
Cups / Case of 48
None
No Medicare rate
70074-0548-47 (4
cups)
Adult Nutritional
54848
Ensure Pudding Butterscotch Delight / 4-oz (113-g) Plastic
Cups / Case of 48
None
No Medicare rate
70074-0548-49 (4
cups)
Adult Nutritional
50240
Glucerna 1.0 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4154
$1.22
70074-0502-41
Adult Nutritional
62671
Glucerna 1.0 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0626-72
Adult Nutritional
51206
Glucerna 1.0 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0512-07
Adult Nutritional
62673
Glucerna 1.0 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4154
mL) Bottle / Case of 6
$1.22
70074-0626-74
Adult Nutritional
52602
Glucerna 1.0 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4154
mL) Bottle / Case of 6
$1.22
70074-0526-03
Adult Nutritional
62675
Glucerna 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4154
mL) Bottle / Case of 6
$1.22
70074-0626-76
Adult Nutritional
50902
Glucerna 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4154
mL) Bottle / Case of 6
$1.22
70074-0509-03
Adult Nutritional
50904
Glucerna 1.2 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4154
$1.22
70074-0509-05
Adult Nutritional
62677
Glucerna 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0626-78
Adult Nutritional
50906
Glucerna 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0509-07
Adult Nutritional
53534
Glucerna 1.5 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4154
$1.22
70074-0535-35
Adult Nutritional
62679
Glucerna 1.5 Cal Ready-to-Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4154
$1.22
70074-0626-80
Adult Nutritional
53536
Glucerna 1.5 Cal Ready-to-Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4154
$1.22
70074-0535-37
Adult Nutritional
62059
Glucerna Hunger Smart Shake Ready-to-Drink Vanilla Retail /
11.5-fl-oz (340-mL) Bottle / Case of 12
B4154
$1.22
70074-0620-60
70074-0620-61 (4
bottles)
Adult Nutritional
62062
Glucerna Hunger Smart Shake Ready-to-Drink Chocolate
Retail / 11.5-fl-oz (340-mL) Bottle / Case of 12
B4154
$1.22
70074-0620-63
70074-0620-64 (4
bottles)
Adult Nutritional
62074
Glucerna Nutrition Bars Crispy Delight / Chocolate Chip / 1.41- None
oz (40-g) Bar / Case of 24
No Medicare rate
70074-0620-75
70074-0620-76 (4 70074062074
bars)
(24 bars)
Adult Nutritional
62077
Glucerna Nutrition Bars Crispy Delight / Peanut Chocolate Chip None
/ 1.41-oz (40-g) Bar / Case of 24
No Medicare rate
70074-0620-78
70074-0620-79 (4 70074062077
bars)
(24 bars)
Adult Nutritional
53742
Glucerna Mini-Snack Bar Cinnamon Bun / 0.70-oz (20-g) Bar / None
Case of 48
No Medicare rate
70074-0537-43 (8
bars)
Adult Nutritional
59704
Glucerna Mini-Snack Bar Oatmeal Raisin / 0.70-oz (20-g) Bar / None
Case of 48
No Medicare rate
70074-0597-05 (8
bars)
Adult Nutritional
59708
Glucerna Mini-Snack Bar Chocolate Peanut / 0.70-oz (20-g)
Bar / Case of 48
None
No Medicare rate
70074-0597-09 (8
bars)
Adult Nutritional
54326
Glucerna Shake Ready-to-Drink Classic Butter Pecan
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0543-27
Adult Nutritional
54328
Glucerna Shake Ready-to-Drink Homemade Vanilla
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0543-29
70074-0626-71 (8
bottles)
70074-0626-73 (6
bottles)
70074-0626-75 (6
bottles)
70074-0626-77 (8
bottles)
70074-0626-79 (8
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Adult Nutritional
54544
Glucerna Shake Ready-to-Drink Rich Chocolate Institutional /
8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0545-45
Adult Nutritional
56052
Glucerna Shake Ready-to-Drink Creamy Strawberry
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0560-53
Adult Nutritional
57801
Glucerna Shake Ready-to-Drink Homemade Vanilla Retail/ 8-fl- B4154
oz Bottle / Case of 24
$1.22
70074-0578-03
Adult Nutritional
57804
Glucerna Shake Ready-to-Drink Rich Chocolate Retail / 8-fl-oz B4154
Bottle / Case of 24
$1.22
70074-0578-06
Adult Nutritional
57807
Glucerna Shake Ready-to-Drink Creamy Strawberry Retail / 8- B4154
fl-oz Bottle / Case of 24
$1.22
70074-0578-09
Adult Nutritional
57810
Glucerna Shake Ready-to-Drink Classic Butter Pecan Retail / 8- B4154
fl-oz Bottle / Case of 24
$1.22
70074-0578-12
Adult Nutritional
53736
Glucerna Snack Bar Blueberry / 1.41-oz (40-g) Bar / Case of
24
None
No Medicare rate
Adult Nutritional
56957
Glucerna Snack Bar Chocolate Caramel / 1.41-oz (40-g) Bar /
Case of 24
None
No Medicare rate
70074-0569-58 (4
bars)
Adult Nutritional
56681
Glucerna Snack Bar Double Chocolate Crisp / 1.41-oz (40-g)
Bar / Case of 24
None
No Medicare rate
70074-0566-82 (4
bars)
Adult Nutritional
57609
Glucerna Snack Bar Caramel Nut / 1.41-oz (40-g) Bar / Case
of 24
None
No Medicare rate
70074-0576-10 (4
bars)
Adult Nutritional
59856
Glucerna Snack Shake Ready-to-Drink Homemade Vanilla
Retail / 8-fl-oz Can / Case of 16
None
No Medicare rate
70074-0598-58
Adult Nutritional
59859
Glucerna Snack Shake Ready-to-Drink Creamy Chocolate
Delight Retail / 8-fl-oz Can / Case of 16
None
No Medicare rate
70074-0598-61
Adult Nutritional
62999
Glucerna Advance/ Chocolate/ 237 mL bottle / Case of 16
B4154
$1.22
70074-0630-00
(4 bottles)
70074-0629-99
(16 bottles)
Adult Nutritional
63001
Glucerna Advance/ Vanilla/ 237 mL bottle / Case of 16
B4154
$1.22
70074-0630-02
(4 bottles)
70074-0630-17
(16 bottles)
Adult Nutritional
63024
Glucerna Nutrition Bars Mini Snacks Oatmeal Raisin / 20g /
case 36 (carton of 6)
None
No Medicare rate
70074-0630-25
70074-0630-26
(6 bars)
70074-0630-24
(36 bars)
Adult Nutritional
63027
Glucerna Nutrition Bars Mini Snacks Chocolate Caramel/ 20g / None
case 36 (carton of 6)
No Medicare rate
70074-0630-28
70074-0630-29
(6 bars)
70074-0630-27
(36 bars)
Adult Nutritional
63030
Glucerna Nutrition Bars Mini Snacks Chocolate Peanut / 20g / None
case 36 (carton of 6)
No Medicare rate
70074-0630-31
70074-0630-32
(6 bars)
70074-0630-30
(36 bars)
Adult Nutritional
58253
Hi-Cal Ready-To-Hang Vanilla Institutional / 1 Liter (1000-mL) B4152
Bottle / Case of 8
$0.55
70074-0582-54
Adult Nutritional
00143
Jevity 1 Cal Ready-to-Drink Institutional / 8-fl-oz (237-mL)
Can / Case of 24
B4150
$0.68
70074-0401-43
Adult Nutritional
62685
Jevity 1 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4150
$0.68
70074-0626-86
Adult Nutritional
00682
Jevity 1 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4150
$0.68
70074-0806-82
Adult Nutritional
62687
Jevity 1 Cal Ready-To-Hang Institutional / 1.5 Liter (1500-mL) B4150
Bottle / Case of 6
$0.68
70074-0626-88
Adult Nutritional
52604
Jevity 1 Cal Ready-To-Hang Institutional / 1.5 Liter (1500-mL) B4150
Bottle / Case of 6
$0.68
70074-0526-05
Adult Nutritional
62667
Jevity 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4150
$0.68
70074-0626-68
Adult Nutritional
53114
Jevity 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4150
$0.68
70074-0531-15
Adult Nutritional
53118
Jevity 1.2 Cal Ready-to-Drink Institutional / 8-fl-oz (237-mL)
Can / Case of 24
B4150
$0.68
70074-0531-19
Adult Nutritional
62683
Jevity 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL) B4150
Bottle / Case of 8
$0.68
70074-0626-84
Adult Nutritional
53124
Jevity 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL) B4150
Bottle / Case of 8
$0.68
70074-0531-25
70074-0537-36
(24 bars)
70074-0626-85 (8
bottles)
70074-0626-87 (6
bottles)
70074-0626-67 (6
bottles)
70074-0626-83 (8
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
Adult Nutritional
62681
Jevity 1.5 Cal Ready-To- Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4152
$0.55
70074-0626-82
Adult Nutritional
57329
Jevity 1.5 Cal Ready-To- Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4152
$0.55
70074-0573-30
Adult Nutritional
62689
Jevity 1.5 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4152
$0.55
70074-0626-90
Adult Nutritional
57331
Jevity 1.5 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4152
$0.55
70074-0573-32
Adult Nutritional
57333
Jevity 1.5 Cal Ready-to-Drink Institutional / 8-fl-oz (237-mL)
Can / Case of 24
B4152
$0.55
70074-0573-34
Adult Nutritional
56094
Juven Powder Unflavored Institutional / 0.68 oz (19.3-g)
Packet / 30 Packets (Outer Carton)
B4155
$0.95
Adult Nutritional
54000
Juven Powder Unflavored Institutional / 0.68-oz (19.3-g)
Packet / Case of 180
B4155
$0.95
Adult Nutritional
56622
Juven Powder Fruit Punch / 0.85-oz (24-g) Packet / 8 Packets B4155
per Box
$0.95
Adult Nutritional
56433
Juven Powder Fruit Punch Institutional / 0.85-oz (24-g) Packet B4155
/ Carton of 30 (Outer Carton)
$0.95
Adult Nutritional
56431
Juven Powder Fruit Punch Institutional / 0.85-oz (24-g) Packet B4155
/ Case of 180
$0.95
Adult Nutritional
56625
Juven Powder Orange Institutional / 0.85-oz (24-g) Packet / 8 B4155
Packets per Box
$0.95
Adult Nutritional
58012
Juven Powder Orange Institutional / 0.85-oz (24-g) Packet /
Carton of 30 (Outer Carton)
B4155
$0.95
Adult Nutritional
57935
Juven Powder Orange Institutional / 0.85-oz (24-g) Packet /
Case of 180
B4155
$0.95
59781-0225-50
Adult Nutritional
53624
Nepro with Carb Steady Ready-to-Drink Homemade Vanilla
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4154
$1.22
70074-0536-26
Adult Nutritional
53627
Nepro with Carb Steady Ready-to-Drink Butter Pecan
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4154
$1.22
70074-0536-29
Adult Nutritional
53633
Nepro with Carb Steady Ready-to-Drink Homemade Vanilla /
8-fl-oz (237-mL) Bottle / Case of 24
B4154
$1.22
70074-0536-34
Adult Nutritional
53630
Nepro with Carb Steady Ready-to-Drink Mixed Berry
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4154
$1.22
70074-0536-32
Adult Nutritional
62669
Nepro with Carb Steady Ready-to-Hang Vanilla Institutional /
1 Liter (1000-mL) Bottle / Case of 8
B4154
$1.22
70074-0626-70
Adult Nutritional
59677
Nepro with Carb Steady Ready-to-Hang Vanilla Institutional /
1 Liter (1000-mL) Bottle / Case of 8
B4154
$1.22
70074-0596-78
Adult Nutritional
62090
Nepro with Carb Steady Ready-to-Drink Butter Pecan
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0620-91
Adult Nutritional
62092
Nepro with Carb Steady Ready-to-Drink Mixed Berry
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0620-93
Adult Nutritional
62094
Nepro with Carb Steady Ready-to-Drink Homemade Vanilla
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0620-95
Adult Nutritional
62691
Osmolite 1 Cal Ready-To-Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4150
$0.68
70074-0626-92
Adult Nutritional
00668
Osmolite 1 Cal Ready-To-Hang Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4150
$0.68
70074-0806-68
Adult Nutritional
00735
Osmolite 1 Cal Ready-to-Drink Institutional / 8-fl-oz (237-mL) B4150
Can / Case of 24
$0.68
70074-0407-35
Adult Nutritional
62695
Osmolite 1 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4150
$0.68
70074-0626-96
Adult Nutritional
52600
Osmolite 1 Cal Ready-To-Hang Institutional / 1.5 Liter (1500mL) Bottle / Case of 6
B4150
$0.68
70074-0526-01
Adult Nutritional
62693
Osmolite 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4150
mL) Bottle / Case of 6
$0.68
70074-0626-94
NDC-Format
NDC-Format
Code for Carton Code for Case
70074-0626-81 (8
bottles)
70074-0626-89 (6
bottles)
59781-0560-94
(30 packets)
59781-0540-02
59781-0540-01
(30 packets)
59781-0540-00
(180 packets)
59781-0566-23 (8
packets)
59781-0564-33
(30 packets)
59781-0564-30
59781-0564-32
(30 packets)
59781-0564-31
(180 packets)
59781-0566-26 (8
packets)
59781-0580-12
(30 packets)
59781-0225-51
(30 packets)
59781-0579-35
(180 packets)
70074-0626-69 (8
bottles)
70074-0626-91 (8
bottles)
70074-0626-95 (6
bottles)
70074-0626-93 (6
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
Adult Nutritional
53116
Adult Nutritional
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
Osmolite 1.2 Cal Ready-To-Hang Institutional / 1.5 Liter (1500- B4150
mL) Bottle / Case of 6
$0.68
70074-0531-17
53120
Osmolite 1.2 Cal Ready-to-Drink Institutional / 8-fl-oz (237mL) Can / Case of 24
B4150
$0.68
70074-0531-21
Adult Nutritional
62697
Osmolite 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4150
mL) Bottle / Case of 8
$0.68
70074-0626-98
Adult Nutritional
53122
Osmolite 1.2 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4150
mL) Bottle / Case of 8
$0.68
70074-0531-23
Adult Nutritional
57469
Osmolite 1.5 Cal Ready-to-Drink Institutional / 8-fl-oz (237mL) Bottle / Case of 24
B4152
$0.55
70074-0574-70
Adult Nutritional
62699
Osmolite 1.5 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4152
mL) Bottle / Case of 8
$0.55
70074-0627-00
Adult Nutritional
57471
Osmolite 1.5 Cal Ready-To-Hang Institutional / 1 Liter (1000- B4152
mL) Bottle / Case of 8
$0.55
70074-0574-72
Adult Nutritional
54386
Oxepa Ready-to-Drink Institutional / 8-fl-oz (237-mL) Can /
Case of 24
B4154
$1.22
70074-0543-87
Adult Nutritional
62717
Oxepa Ready-To-Hang Institutional / 1 Liter (1000-mL) Bottle B4154
/ Case of 8
$1.22
70074-0627-18
Adult Nutritional
57043
Oxepa Ready-To-Hang Institutional / 1 Liter (1000-mL) Bottle B4154
/ Case of 8
$1.22
70074-0570-44
Adult Nutritional
50628
Perative Ready-to-Drink Institutional / 8-fl-oz (237-mL) Can /
Case of 24
B4153
$1.91
70074-0506-29
Adult Nutritional
62723
Perative Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4153
$1.91
70074-0627-24
Adult Nutritional
51948
Perative Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4153
$1.91
70074-0519-49
Adult Nutritional
62671
Perative Ready-To-Hang Institutional / 1.5 Liter (1500-mL)
Bottle / Case of 6
B4153
$1.91
70074-0627-22
Adult Nutritional
57635
Perative Ready-To-Hang Institutional / 1.5 Liter (1500-mL)
Bottle / Case of 6
B4153
$1.91
70074-0576-36
Adult Nutritional
58013
Pivot 1.5 Cal Ready-to-Drink Institutional / 8-fl-oz (237-mL)
Can / Case of 24
B4153
$1.91
70074-0580-14
Adult Nutritional
62719
Pivot 1.5 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL) B4153
Bottle / Case of 8
$1.91
70074-0627-20
Adult Nutritional
58015
Pivot 1.5 Cal Ready-To-Hang Institutional / 1 Liter (1000-mL) B4153
Bottle / Case of 8
$1.91
70074-0580-16
Adult Nutritional
00746
Polycose Powder Institutional / 12.3-oz (349-g) Can / Case of B4155
6
$0.95
70074-0607-46
Adult Nutritional
59721
ProMod Liquid Protein Ready-to-Drink Fruit Punch Institutional B4155
/ 32-fl-oz (946-mL) Bottle / Case of 6
$0.95
70074-0597-22
Adult Nutritional
50774
Promote Ready-to-Drink Vanilla Institutional / 8-fl-oz (237mL) Can / Case of 24
B4150
$0.68
70074-0507-75
Adult Nutritional
62701
Promote Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4150
$0.68
70074-0627-02
Adult Nutritional
51616
Promote Ready-To-Hang Institutional / 1 Liter (1000-mL)
Bottle / Case of 8
B4150
$0.68
70074-0516-17
Adult Nutritional
62705
Promote Ready-To-Hang Institutional / 1.5 Liter (1500-mL)
Bottle / Case of 6
B4150
$0.68
70074-0627-06
Adult Nutritional
57631
Promote Ready-To-Hang Institutional / 1.5 Liter (1500-mL)
Bottle / Case of 6
B4150
$0.68
70074-0576-32
Adult Nutritional
51872
Promote With Fiber Ready-to-Drink Vanilla Institutional / 8-fl- B4150
oz (237-fl-oz) Can / Case of 24
$0.68
70074-0518-73
Adult Nutritional
62703
Promote With Fiber Ready-To-Hang Institutional / 1 Liter
(1000-mL) Bottle / Case of 8
B4150
$0.68
70074-0627-04
Adult Nutritional
51874
Promote With Fiber Ready-To-Hang Institutional / 1 Liter
(1000-mL) Bottle / Case of 8
B4150
$0.68
70074-0518-75
NDC-Format
NDC-Format
Code for Carton Code for Case
70074-0626-97 (8
bottles)
70074-0626-99 (8
bottles)
70074-0627-17 (8
bottles)
70074-0627-23 (8
bottles)
70074-0627-21 (6
bottles)
70074-0627-19 (8
bottles)
70074-0627-01 (8
bottles)
70074-0627-05 (6
bottles)
70074-0627-03 (8
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Adult Nutritional
62707
Promote With Fiber Ready-To-Hang Institutional / 1.5 Liter
(1500-mL) Bottle / Case of 6
B4150
$0.68
70074-0627-08
Adult Nutritional
57633
Promote With Fiber Ready-To-Hang Institutional / 1.5 Liter
(1500-mL) Bottle / Case of 6
B4150
$0.68
70074-0576-34
Adult Nutritional
00699
Pulmocare Ready-to-Drink Vanilla Institutional / 8-fl-oz (237mL) Can / Case of 24
B4154
$1.22
70074-0406-99
Adult Nutritional
62725
Pulmocare Ready-To-Hang Vanilla Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0627-26
Adult Nutritional
51204
Pulmocare Ready-To-Hang Vanilla Institutional / 1 Liter (1000- B4154
mL) Bottle / Case of 8
$1.22
70074-0512-05
Adult Nutritional
53636
Suplena with Carb Steady Ready-to-Drink Homemade Vanilla
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4154
$1.22
70074-0536-38
Adult Nutritional
62088
Suplena w Carb Steady Ready-to-Drink Homemade Vanilla
Institutional / 8 fl-oz (237-mL) Can / Case of 24
B4154
$1.22
70074-0620-89
Adult Nutritional
00729
TwoCal HN Ready-to-Drink Vanilla Institutional / 8-fl-oz (237- B4152
mL) Can / Case of 24
$0.55
70074-0407-29
Adult Nutritional
54064
TwoCal HN Ready-to-Drink Butter Pecan Institutional / 8-fl-oz B4152
(237-mL) Can / Case of 24
$0.55
70074-0540-65
Adult Nutritional
62709
TwoCal HN Ready-To-Hang Vanilla Institutional / 1 Liter (1000- B4152
mL) Bottle / Case of 8
$0.55
70074-0627-10
Adult Nutritional
57047
TwoCal HN Ready-To-Hang Vanilla Institutional / 1 Liter (1000- B4152
mL) Bottle / Case of 8
$0.55
70074-0570-48
Adult Nutritional
56542
Vital AF 1.2 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4153
$1.91
70074-0627-15
Adult Nutritional
56542
Vital AF 1.2 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4153
$1.91
70074-0565-43
Adult Nutritional
62069
Vital AF 1.2 Cal Ready-to-Hang Vanilla Institutional / 1.5 Liter B4153
(1500-mL) Bottle/ Case of 6
$1.91
70074-0565-43
Adult Nutritional
62715
Vital AF 1.2 Cal Ready-to-Hang Vanilla Institutional / 1 Liter
(1000-mL) Bottle / Case of 8
B4153
$1.91
70074-0627-16
Adult Nutritional
56544
Vital AF 1.2 Cal Ready-to-Hang Vanilla Institutional / 1 Liter
(1000-mL) Bottle / Case of 8
B4153
$1.91
70074-0565-45
Adult Nutritional
56277
Vital 1.0 Ready-to-Drink Vanilla Institutional / 8-fl-oz (237-mL) B4153
Can / Case of 24
$1.91
70074-0562-78
Adult Nutritional
62067
Vital 1.0 Cal Ready-to-Hang Vanilla Institutional / 1.5 Liter
(1500-mL) Bottle / Case of 6
B4153
$1.91
70074-0620-68
70074-0620-67 (6
bottles)
Adult Nutritional
62711
Vital 1.0 Ready-to-Hang Vanilla Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4153
$1.91
70074-0627-12
70074-0627-11 (8
bottles)
Adult Nutritional
56281
Vital 1.0 Ready-to-Hang Vanilla Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4153
$1.91
70074-0562-82
Adult Nutritional
56279
Vital 1.5 Ready-to-Drink Vanilla Institutional / 8-fl-oz (237-mL) B4153
Can / Case of 24
$1.91
70074-0562-80
Adult Nutritional
62713
Vital 1.5 Ready-To-Hang Vanilla Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4153
$1.91
70074-0627-14
Adult Nutritional
56283
Vital 1.5 Ready-To-Hang Vanilla Institutional / 1 Liter (1000mL) Bottle / Case of 8
B4153
$1.91
70074-0562-84
Adult Nutritional
62071
Vital 1.5 Ready-To-Hang Vanilla Institutional / 1.5 Liter (1500- B4153
mL) Bottle / Case of 6
$1.91
70074-0620-72
Adult Nutritional
00766
Vital HN Powder Vanilla Institutional / 2.79-oz (79-g) Packet / B4153
Case of 24
$1.91
Metabolic
53328
Calcilo XD Powder Institutional / 13.2-oz (375-g) Can / Case
of 6
B4162
No Medicare rate
70074-0533-29
Metabolic
51144
Cyclinex-1 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162
No Medicare rate
70074-0511-45
Metabolic
51146
Cyclinex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162 (Ped)
No Medicare rate
70074-0511-47
70074-0627-07 (6
bottles)
70074-0627-25 (8
bottles)
70074-0627-09 (8
bottles)
70074-0627-16 (8
bottles)
70074-0627-15 (8
bottles)
70074-0627-13 (8
bottles)
70074-0620-71 (6
bottles)
70074-0407-66 (6
packets)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
Metabolic
51146
Cyclinex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4157 (Adult)
No Medicare rate
70074-0511-47
Metabolic
51140
Glutarex-1 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162
No Medicare rate
70074-0511-41
Metabolic
51142
Glutarex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162 (Ped)
No Medicare rate
70074-0511-43
Metabolic
51142
Glutarex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4157 (Adult)
No Medicare rate
70074-0511-43
Metabolic
51116
Hominex-1 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162
No Medicare rate
70074-0511-17
Metabolic
51118
Hominex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162 (Ped)
No Medicare rate
70074-0511-19
Metabolic
51118
Hominex-2 Powder Institutional / 14.1-oz (400-g) Can / Case B4157 (Adult)
of 6
No Medicare rate
70074-0511-19
Metabolic
51136
I-Valex-1 Powder Institutional / 14.1-oz (400-g) Can / Case of B4162
6
No Medicare rate
70074-0511-37
Metabolic
51138
I-Valex-2 Powder Institutional / 14.1-oz (400-g) Can / Case of B4162 (Ped)
6
No Medicare rate
70074-0511-39
Metabolic
51138
I-Valex-2 Powder Institutional / 14.1-oz (400-g) Can / Case of B4157 (Adult)
6
No Medicare rate
70074-0511-39
Metabolic
51112
Ketonex-1 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162
No Medicare rate
70074-0511-13
Metabolic
51114
Ketonex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4162 (Ped)
No Medicare rate
70074-0511-15
Metabolic
51114
Ketonex-2 Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
B4157 (Adult)
No Medicare rate
70074-0511-15
Metabolic
51120
Phenex-1 Powder Institutional / 14.1-oz (400-g) Can / Case of B4162
6
No Medicare rate
70074-0511-21
Metabolic
51122
Phenex-2 Powder Institutional / 14.1-oz (400-g) Can / Case of B4162 (Ped)
6
No Medicare rate
70074-0511-23
Metabolic
51122
Phenex-2 Powder Institutional / 14.1-oz (400-g) Can / Case of B4157 (Adult)
6
No Medicare rate
70074-0511-23
Metabolic
55755
Phenex-2 Powder Vanilla Institutional / 14.1-oz (400-g) Can / B4157 (Adult)
Case of 6
No Medicare rate
70074-0557-56
Metabolic
55755
Phenex-2 Powder Vanilla Institutional / 14.1-oz (400-g) Can / B4162 (Ped)
Case of 6
No Medicare rate
70074-0557-56
Metabolic
51148
Pro-Phree Powder Institutional / 14.1-oz (400-g) Can / Case
of 6
$0.95
70074-0511-49
Metabolic
51132
Propimex-1 Powder Institutional / 14.1-oz (400-g) Can / Case B4162
of 6
No Medicare rate
70074-0511-33
Metabolic
51134
Propimex-2 Powder Institutional / 14.1-oz (400-g) Can / Case B4162 (Ped)
of 6
No Medicare rate
70074-0511-35
Metabolic
51134
Propimex-2 Powder Institutional / 14.1-oz (400-g) Can / Case B4157 (Adult)
of 6
No Medicare rate
70074-0511-35
Metabolic
50260
ProViMin Powder Institutional / 5.3-oz (150-g) Can / Case of 6 B4155
$0.95
Metabolic
00108
RCF Concentrated Liquid Institutional / 13-fl-oz (384-mL) Can B4155
/ Case of 12
$0.95
70074-0401-08
Metabolic
51128
Tyrex-1 Powder Institutional / 14.1-oz (400-g) Can / Case of 6 B4162
No Medicare rate
70074-0511-29
Metabolic
51126
Tyrex-2 Institutional Powder / 14.1-oz (400-g) Can / Case of 6 B4162 (Ped)
No Medicare rate
70074-0511-27
Metabolic
51126
Tyrex-2 Institutional Powder / 14.1-oz (400-g) Can / Case of 6 B4157 (Adult)
No Medicare rate
70074-0511-27
Pediatric Nutritional
53510
EleCare with DHA and ARA Powder Institutional / 14.1-oz
(400-g) Can / Case of 6
No Medicare rate
70074-0535-11
B4155
B4161
NDC-Format
NDC-Format
Code for Carton Code for Case
70074-0502-60 (6
cans)
70074-0535-10 (6
cans)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
Pediatric Nutritional
54665
Pediatric Nutritional
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
EleCare Powder Institutional / 14.1-oz (400-g) Can / Case of 6 B4161
No Medicare rate
70074-0546-66
70074-0546-65 (6
cans)
59405
EleCare Vanilla Powder Institutional / 14.1-oz (400-g) Can /
Case of 6
B4161
No Medicare rate
70074-0594-06
70074-0594-05 (6
cans)
Pediatric Nutritional
56585
EleCare Jr Vanilla Powder Institutional / 14.1-oz (400-g) Can / B4161
Case of 6
No Medicare rate
70074-0565-86
Pediatric Nutritional
55253
EleCare Jr Unflavored Powder Institutional / 14.1-oz (400-g)
Can / Case of 6
B4161
No Medicare rate
70074-0552-54
Pediatric Nutritional
55251
EleCare for Infants (DHA/ARA) Powder Institutional / 14.1-oz
(400-g) Can / Case of 6
B4161
No Medicare rate
70074-0535-11
Pediatric Nutritional
00240
Pedialyte Ready-to-Drink Grape Retail / 33.8 fl-oz (1-Liter)
Bottle / Case of 8
B4103
No Medicare rate
70074-0802-40
Pediatric Nutritional
00336
Pedialyte Ready-to-Drink Unflavored Retail/ 33.8 fl-oz (1-Liter) B4103
Bottle / Case of 8
No Medicare rate
70074-0803-36
Pediatric Nutritional
00365
Pedialyte Ready-to-Drink Fruit Retail / 33.8 fl-oz (1-Liter)
Bottle / Case of 8
B4103
No Medicare rate
70074-0803-65
Pediatric Nutritional
51752
Pedialyte Ready-to-Drink Bubble Gum Retail / 33.8 fl-oz (1Liter) Bottle / Case of 8
B4103
No Medicare rate
70074-0517-53
Pediatric Nutritional
53983
Pedialyte Ready-to-Drink Strawberry Retail/ 33.8 fl-oz (1-Liter) B4103
Bottle / Case of 8
No Medicare rate
70074-0539-84
Pediatric Nutritional
00245
Pedialyte Freezer Pops Variety Retail / 2.1-oz (62.5-mL)
Sleeve / Case of 128
B4103
No Medicare rate
70074-0002-46
(16 sleeves)
Pediatric Nutritional
56078
Pedialyte Powder Pack Apple Retail / 0.3-oz (8.5-g) Packet /
Case of 40
B4103
No Medicare rate
70074-0560-79 (4
packets)
Pediatric Nutritional
56081
Pedialyte Powder Pack Fruit Punch Retail / 0.3-oz (8.5-g)
Packet / Case of 40
B4103
No Medicare rate
70074-0560-82 (4
packets)
Pediatric Nutritional
56090
Pedialyte Powder Pack Variety Retail (2 each - Fruit Punch,
Grape, Apple, Strawberry) / 0.3-oz Packet / Case of 64
B4103
No Medicare rate
70074-0560-91 (8
packets)
Pediatric Nutritional
56435
Pedialyte Singles Ready-to-Drink Fruit Retail / 6.8-fl-oz (200mL) Carton / Case of 16
B4103
No Medicare rate
70074-0564-37
70074-0564-36 (4
tetras)
Pediatric Nutritional
56438
Pedialyte Singles Ready-to-Drink Apple Retail / 6.8-fl-oz (200- B4103
mL) Carton / Case of 16
No Medicare rate
70074-0564-40
70074-0564-39 (4
tetras)
Pediatric Nutritional
56441
Pedialyte Singles Ready- to-Drink Cherry Retail / 6.8-fl-oz (200- B4103
mL) Carton / Case of 16
No Medicare rate
70074-0564-43
70074-0564-42 (4
tetras)
Pediatric Nutritional
56416
PediaSure Sidekicks Ready-to-Drink Vanilla Retail / 8-fl-oz
(237-mL) Bottle / Case of 16
None
No Medicare rate
Pediatric Nutritional
56523
PediaSure Sidekicks 0.63 Cal Ready-to-Drink Vanilla
Institutional / 8-fl-oz (237-mL) Bottle / Case of 24
B4158
No Medicare Rate
70074-0565-24
Pediatric Nutritional
62311
PediaSure Sidekicks Clear Ready-to-Drink Wild Berry
Institutional / 6.8-fl-oz (200-mL) Tetra / Case of 32
B4155
$0.95
70074-0623-12
Pediatric Nutritional
62309
PediaSure Sidekicks Clear Ready-to-Drink Tropical Fruit
Institutional / 6.8-fl-oz (200-mL) Tetra / Case of 32
B4155
$0.95
70074-0623-10
Pediatric Nutritional
62486
PediaSure Sidekicks Ready-to-Drink Vanilla Retail / 8-fl-oz
(237-mL) Bottle / Case of 24
None
No Medicare rate
70074-0624-87 (6
bottles)
Pediatric Nutritional
56419
PediaSure Sidekicks Ready-to-Drink Chocolate Retail / 8-fl-oz
(237-mL) Bottle / Case of 16
None
No Medicare rate
70074-0564-20 (4
bottles)
Pediatric Nutritional
62484
PediaSure Sidekicks Ready-to-Drink Chocolate Retail / 8-fl-oz
(237-mL) Bottle / Case of 24
None
No Medicare rate
70074-0624-85 (6
bottles)
Pediatric Nutritional
56422
PediaSure Sidekicks Ready-to-Drink Strawberry Retail / 8-fl-oz None
(237-mL) Bottle / Case of 16
No Medicare rate
70074-0564-23 (4
bottles)
Pediatric Nutritional
62482
PediaSure Sidekicks Ready-to-Drink Strawberry Retail / 8-fl-oz None
(237-mL) Bottle / Case of 24
No Medicare rate
70074-0624-83 (6
bottles)
Pediatric Nutritional
57464
PediaSure Sidekicks Ready-to-Drink Chocolate Club Pack / 8-fl- None
oz (237-mL) Bottle / Case of 16
No Medicare rate
Pediatric Nutritional
62130
PediaSure Sidekicks Clear Ready-to-Drink Wild Berry Retail /
6.8-fl-oz (200-mL) Tetra / Case of 32
$0.95
B4155
NDC-Format
NDC-Format
Code for Carton Code for Case
70074-0564-17 (4
bottles)
70074-0574-64
(16 bottles)
70074-0621-31
70074-0621-32 (8 70074-0621-30
tetras)
(32 tetras)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Pediatric Nutritional
62125
PediaSure Sidekicks Clear Ready-to-Drink Tropical Fruit Retail
/ 6.8-fl-oz (200-mL) Tetra / Case of 32
B4155
$0.95
70074-0621-26
70074-0621-27 (8 70074-0621-25
tetras)
(32 tetras)
Pediatric Nutritional
51880
PediaSure Ready-to-Drink Strawberry Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4160
No Medicare rate
70074-0518-81
Pediatric Nutritional
51882
PediaSure Ready-to-Drink Chocolate Institutional / 8-fl-oz
(237-mL) Can / Case of 24
B4160
No Medicare rate
70074-0518-83
Pediatric Nutritional
51884
PediaSure Ready-to-Drink Banana Institutional / 8-fl-oz (237mL) Can / Case of 24
B4160
No Medicare rate
70074-0518-85
Pediatric Nutritional
53581
PediaSure Ready-to-Drink Vanilla Institutional / 8-fl-oz (237mL) Bottle / Case of 24
B4160
No Medicare rate
70074-0535-82
Pediatric Nutritional
53587
PediaSure Ready-to-Drink Chocolate Institutional / 8-fl-oz
(237-mL) Bottle / Case of 24
B4160
No Medicare rate
70074-0535-88
Pediatric Nutritional
53589
PediaSure Ready-to-Drink Strawberry Institutional / 8-fl-oz
(237-mL) Bottle / Case of 24
B4160
No Medicare rate
70074-0535-90
Pediatric Nutritional
53818
PediaSure Ready-to-Drink Berry Retail / 8-fl-oz Bottle / Case
of 24
B4160
No Medicare rate
Pediatric Nutritional
55897
PediaSure Ready-to-Drink Vanilla Institutional / 8-fl-oz (237mL) Can / Case of 24
B4160
No Medicare rate
Pediatric Nutritional
58049
PediaSure Ready-to-Drink Vanilla Retail / 8-fl-oz Bottle / Case B4160
of 24
No Medicare rate
70074-0580-50 (6
bottles)
Pediatric Nutritional
58052
PediaSure Ready-to-Drink Banana Retail / 8-fl-oz Bottle / Case B4160
of 24
No Medicare rate
70074-0580-53 (6
bottles)
Pediatric Nutritional
58055
PediaSure Ready-to-Drink Strawberry Retail / 8-fl-oz Bottle /
Case of 24
B4160
No Medicare rate
70074-0580-56 (6
bottles)
Pediatric Nutritional
58058
PediaSure Ready-to-Drink Chocolate Retail / 8-fl-oz Bottle /
Case of 24
B4160
No Medicare rate
70074-0580-59 (6
bottles)
Pediatric Nutritional
56409
PediaSure 1.5 Cal Ready-to-Drink Vanilla Institutional / 8-fl-oz B4160
(237-mL) Can / Case of 24
No Medicare rate
70074-0564-10
Pediatric Nutritional
56411
PediaSure 1.5 Cal with Fiber Ready-to-Drink Vanilla
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4160
No Medicare rate
70074-0564-12
Pediatric Nutritional
62749
PediaSure 1.5 Cal with Fiber Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL ) Bottle / Case of 8
B4160
No Medicare rate
70074-0627-50
70074-0627-49 (8
bottles)
Pediatric Nutritional
62022
PediaSure 1.5 Cal with Fiber Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL ) Bottle / Case of 8
B4160
No Medicare rate
70074-0620-23
70074-0620-22
(8 bottles)
Pediatric Nutritional
51804
PediaSure Enteral Formula 1.0 Cal Ready-to-Drink Vanilla
Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4160
No Medicare rate
70074-0518-05
Pediatric Nutritional
62727
PediaSure Enteral Formula 1.0 Cal with Fiber Ready-to-Hang B4160
Unflavored Institutional / 1 Liter (1000-mL ) Bottle / Case of 8
No Medicare rate
70074-0627-28
70074-0627-27 (8
bottles)
Pediatric Nutritional
62020
PediaSure Enteral Formula 1.0 Cal with Fiber Ready-to-Hang B4160
Unflavored Institutional / 1 Liter (1000-mL ) Bottle / Case of 8
No Medicare rate
70074-0620-21
70074-0620-20 (8
bottles)
Pediatric Nutritional
51806
PediaSure Enteral Formula 1.0 Cal with Fiber Ready-to-Drink
Vanilla Institutional / 8-fl-oz (237-mL) Can / Case of 24
B4160
No Medicare rate
70074-0518-07
Pediatric Nutritional
62119
PediaSure Peptide 1.0 Cal Ready-to-Drink Vanilla Institutional B4161
/ 8-fl-oz (237-mL) Bottle / Case of 24
No Medicare rate
70074-0621-20
Pediatric Nutritional
62121
PediaSure Peptide 1.0 Cal Ready-to-Drink Strawberry
Institutional / 8-fl-oz (237 mL) Bottle / Case of 24
B4161
No Medicare rate
70074-0621-22
Pediatric Nutritional
62123
PediaSure Peptide 1.0 Cal Ready-to-Drink Unflavored
Institutional / 8-fl-oz (237 mL) Bottle / Case of 24
B4161
No Medicare rate
70074-0621-24
Pediatric Nutritional
62729
PediaSure Peptide 1.0 Cal Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL) Bottle / Case of 8
B4161
No Medicare rate
70074-0627-30
70074-0627-29 (8
bottles)
Pediatric Nutritional
62051
PediaSure Peptide 1.0 Cal Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL) Bottle / Case of 8
B4161
No Medicare rate
70074-0620-52
70074-0620-51 (8
bottles)
Pediatric Nutritional
56655
PediaSure Peptide 1.5 Cal Ready-to-Drink Vanilla Institutional B4161
/ 8-fl-oz (237-mL) Bottle / Case of 24
No Medicare rate
70074-0566-56
Pediatric Nutritional
62731
PediaSure Peptide 1.5 Cal Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL) Bottle / Case of 8
No Medicare rate
70074-0627-32
B4161
70074-0538-19 (6
bottles)
70074-0558-98
70074-0627-31 (8
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Pediatric Nutritional
62014
PediaSure Peptide 1.5 Cal Ready-to-Hang Unflavored
Institutional / 1 Liter (1000-mL) Bottle / Case of 8
B4161
No Medicare rate
70074-0620-15
Pediatric Nutritional
53585
PediaSure with Fiber Ready-to-Drink Vanilla Institutional / 8-fl- B4160
oz (237-mL) Bottle / Case of 24
No Medicare rate
70074-0535-86
Pediatric Nutritional
58061
PediaSure with Fiber Ready-to-Drink Vanilla Retail / 8-fl-oz
Bottle / Case of 24
B4160
No Medicare rate
70074-0580-62 (6
bottles)
Pediatric Nutritional
56368
PediaSure with Fiber Ready-to-Drink Strawberry Retail / 8-floz Bottle / Case of 24
B4160
No Medicare rate
70074-0563-69 (6
bottles)
Pediatric Nutritional
58220
PediaSure with Fiber Ready-to-Drink Vanilla Institutional / 8-fl- B4160
oz (237-mL) Can / Case of 24
No Medicare rate
70074-0582-21
Pediatric Nutritional
00108
RCF Concentrated Liquid Institutional / 13-fl-oz (384-mL) Can B4155
/ Case of 12
$0.95
70074-0401-08
Pediatric Nutritional
62427
Similac Prenatal Dietary Supplement / 4 x 3 30-ct each
multivit/min tablets and DHA/lutein softgels
None
No Medicare rate
Pediatric Nutritional
57508
Similac Expert Care Alimentum Ready-to-Feed / 8-fl-oz (237mL) Can / Case of 24
B4161
No Medicare rate
70074-0575-09
Pediatric Nutritional
57512
Similac Expert Care Alimentum Ready-to-Feed / 1 Quart (946- B4161
mL) Bottle / Case of 6
No Medicare rate
70074-0575-13
Pediatric Nutritional
57663
Similac Expert Care Alimentum Powder / 1-lb (454-g) Can /
Case of 6
B4161
No Medicare rate
70074-0576-64
Pediatric Nutritional
51276
Similac Expert Care Diarrhea Ready-to-Feed / 8-fl-oz (237-mL) B4159
Can / Case of 24
No Medicare rate
70074-0512-77
Pediatric Nutritional
57768
Similac Expert Care Diarrhea Ready-to-Feed / 1-Quart (946mL) Bottle / Case of 6
B4159
No Medicare rate
70074-0577-69
Pediatric Nutritional
57430
Similac Expert Care NeoSure Powder / 13.1-oz (371-g) Can /
Case of 6
B4160
No Medicare rate
70074-0574-31
Pediatric Nutritional
57455
Similac Expert Care NeoSure Ready-to-Feed / 1-Quart (946mL) Bottle/ Case of 6
B4160
No Medicare rate
70074-0574-56
Pediatric Nutritional
59645
Similac Expert Care NeoSure Ready-to-Feed Retail/ 2-fl-oz (59- B4160
mL) Bottle/ Case of 48
No Medicare rate
Pediatric Nutritional
50827
Similac Go & Grow Milk-Based Formula Powder / 1.37-lb (623- B4158
g) SimplePac / Case of 6
No Medicare rate
70074-0508-28
Pediatric Nutritional
50837
Similac Go & Grow Soy-Based Powder / 1.37-lb (623-g)
SimplePac / Case of 6
B4159
No Medicare rate
70074-0508-38
Pediatric Nutritional
50959
Similac For Spit-Up Powder / 12.3-oz (349-g) Can / Case of 6
B4158
No Medicare rate
70074-0509-60
70074-0509-59 (6
cans)
Pediatric Nutritional
53729
Similac For Spit-Up Powder / 1.41-lb (638-g) SimplePac / Case B4158
of 6
No Medicare rate
70074-0537-30
70074-0537-29 (6
cans)
Pediatric Nutritional
56728
Similac For Spit-Up Ready-to-Feed / 1-Quart (946-mL) Bottle / B4158
Case of 6
No Medicare rate
70074-0567-31
70074-0567-28 (6
bottles)
Pediatric Nutritional
50817
Similac Sensitive Powder / 1.41-lb (638-g) SimplePac / Case
of 6
B4158
No Medicare rate
70074-0508-18
Pediatric Nutritional
53445
Similac Sensitive Club Powder / 2.12-lb (963-g) SimplePac /
Case of 6
B4158
No Medicare rate
70074-0534-46
Pediatric Nutritional
56258
Similac Sensitive Concentrated Liquid / 1-Quart (946-mL)
Bottle / Case of 6
B4158
No Medicare rate
70074-0562-59
Pediatric Nutritional
57533
Similac Sensitive Ready-to-Feed / 1-Quart (946-mL) Bottle /
Case of 6
B4158
No Medicare rate
70074-0575-34
Pediatric Nutritional
57535
Similac Sensitive Concentrated Liquid / 13-fl-oz (384-mL) Can B4158
/ Case of 12
No Medicare rate
70074-0575-36
Pediatric Nutritional
57539
Similac Sensitive Powder / 12.6-oz (357-g) Can / Case of 6
B4158
No Medicare rate
70074-0575-41
Pediatric Nutritional
53676
Similac Sensitive On-the-Go Ready-to-Feed / 8-fl-oz (237-mL) B4158
Bottle / Case of 24
No Medicare rate
70074-0560-92
Pediatric Nutritional
53359
Similac Advance Powder / 1.45-lb (657-g) SimplePac / Case of B4158
6
No Medicare rate
70074-0533-60
70074-0620-14 (8
bottles)
70074-0624-28 (1 70074-0624-27
Box)
(12 Boxes)
70074-0578-86 (6
cans)
70074-0596-46 (8
bottles)
70074-0562-58 (6
bottles)
70074-0536-77 (6
bottles)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Pediatric Nutritional
53363
Similac Advance Ready-to-Feed / 1-Quart (946-mL) Bottle /
Case of 6
B4158
No Medicare rate
70074-0533-64
Pediatric Nutritional
53496
Similac Advance Club Powder / 2.12-lb (963-g) SimplePac /
Case of 6
B4158
No Medicare rate
70074-0534-97
Pediatric Nutritional
53526
Similac Advance On-the-Go Ready-to-Feed / 8-fl-oz (237-mL)
Bottle / Case of 12
B4158
No Medicare rate
Pediatric Nutritional
55957
Similac Advance Powder / 12.4-oz (352-g) Can / Case of 6
B4158
No Medicare rate
70074-0559-58
Pediatric Nutritional
56250
Similac Advance Concentrated Liquid / 1-Quart (946-mL)
Bottle / Case of 6
B4158
No Medicare rate
70074-0562-51
Pediatric Nutritional
56973
Similac Advance Concentrated Liquid / 13-fl-oz (384-mL) Can
/ Case of 12
B4158
No Medicare rate
70074-0569-74
Pediatric Nutritional
57600
Similac Advance Newborn Bottles Ready-to-Feed Retail / 2-floz (59 mL) Bottle / Case of 48
B4158
No Medicare rate
70074-0576-01 (8
bottles)
Pediatric Nutritional
57938
Similac Advance On-the-Go Powder Singles / 0.61-oz (17.4-g) B4158
Packets / Case of 96
No Medicare rate
70074-0579-39
(16 packets)
Pediatric Nutritional
58605
Similac Advance On-the-Go Ready-to-Feed / 8-fl-oz (237-mL)
Bottle / Case of 24
B4158
No Medicare rate
70074-0586-14
Pediatric Nutritional
54598
Similac Human Milk Fortifier Powder Institutional / 0.9-g
Packet / Case of 150
None
No Medicare rate
70074-0545-99
(50 packets)
Pediatric Nutritional
50821
Similac Organic Powder / 1.45-lb (657-g) SimplePac / Case of B4158
6
No Medicare rate
70074-0508-22
Pediatric Nutritional
59883
Similac Organic Ready-to-Feed / 1-Quart (946-mL) Bottle /
Case of 6
B4158
No Medicare rate
70074-0598-84
Pediatric Nutritional
00850
Similac PM 60/40 Powder / 14.1-oz (400-g) Can / Case of 6
B4154
$1.22
70074-0608-50
Pediatric Nutritional
50819
Similac Soy Isomil Powder / 1.45-lb (657-g) SimplePac / Case B4159
of 6
No Medicare rate
70074-0508-20
Pediatric Nutritional
55963
Similac Soy Isomil Powder / 12.4-oz (352-g) Can / Case of 6
B4159
No Medicare rate
70074-0559-64
Pediatric Nutritional
55967
Similac Soy Isomil Ready-to-Feed / 1-Quart (946-mL) Bottle / B4159
Case of 6
No Medicare rate
70074-0559-68
Pediatric Nutritional
56975
Similac Soy Isomil Concentrated Liquid / 13-fl-oz (384-mL)
Can / Case of 12
B4159
No Medicare rate
70074-0569-76
Pediatric Nutritional
56982
Similac Soy Isomil On-the-Go Powder Singles / 0.62-oz (17.6- B4159
g) Packets / Case of 96
No Medicare rate
Pediatric Nutritional
58601
Similac Soy Isomil On-the-Go Ready-to-Feed / 8-fl-oz (237mL) Bottle / Case of 24
B4159
No Medicare rate
70074-0586-04
Pediatric Nutritional
50825
Similac Soy Isomil CLUB Powder / 2.13-lb (964-gm) SimplePac B4159
/ Case of 6
No Medicare rate
70074-0508-26
Pediatric Nutritional
59582
Similac Special Care 24 with Iron Ready-to-Feed Retail / 2-floz (59-mL) Bottle / Case of 48
B4160
No Medicare rate
Pediatric Nutritional
56294
Similac Special Care 30 With Iron Ready-to-Feed Retail / 2-floz (59-mL) Bottle / Case of 48
B4160
No Medicare rate
Pediatric Nutritional
62082
PediaSure Vanilla 16ct
B4160
No Medicare rate
70041-0624-95
70074-0620-82
Pediatric Nutritional
63013
Similac For Supplementation / 1.45-lb (658-gm) Powder /
Case of 6
B4158
No Medicare rate
70074-0629-50
70074-0630-13 (4
units)
Pediatric Nutritional
62990
Similac For Supplementation / 2-fl-oz (59-mL) Bottle / Case of B4158
48
No Medicare rate
Pediatric Nutritional
63057
Pedialyte AdvancedCare Cherry Punch / 1 Liter (1000-mL) /
Liquid/ Case 8
B4103
No Medicare rate
70074-0630-58
70074-0630-57 (8
bottles)
Pediatric Nutritional
63059
Pedialyte AdvancedCare Blue Raspberry / 1 Liter (1000-mL /
Liquid/ Case 9
B4103
No Medicare rate
70074-0630-60
70074-0630-59 (8
bottles)
Pediatric Nutritional
56649
Similac Human Milk Fortifier Concentrated Liquid Institutional
/ 5-mL Packet / Case of 144
B4155
$0.95
70074-0566-50
70074-0586-03 (6
bottles)
70074-0508-25 (6
cans)
70074-0562-95 (8
bottles)
70074-0629-91 (8 70074-0629-90
bottles)
(48 bottles)
70074-0566-49
(144 packets)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Category
Item
#
SKU Description
Pediatric Nutritional
62595
Pediatric Nutritional
Pediatric Nutritional
HCPCS
Code
Med B Allow
Rate
(per 100 Cal)
NDC-Format
Code for Single
NDC-Format
NDC-Format
Code for Carton Code for Case
Similac Total Comfort Ready-to-Feed Institutional / 2-fl-oz (59- B4158
mL) Bottle / Case of 48
No Medicare rate
70074-0625-96
70074-0625-95
(48 bottles)
62597
Similac Total Comfort Powder / 1.41-lb (638-g) SimplePac /
Case of 4
B4158
No Medicare rate
70074-0625-98
70074-0625-97
(4 SimplePacs)
62599
Similac Total Comfort Powder / 12.6 oz Can / Case of 6
B4158
No Medicare rate
70074-0626-00
70074-0625-99
(6 cans)
NDC-format codes have been submitted by Abbott Nutrition to data warehouses. While Abbott Nutrition cannot confirm that NDC-format
codes have been published, the codes listed are based on the formatting established by NDC data warehouses.
Related documents