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

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.