PRODUCT

HCPCS

ML/CALORIES

PER CAN

CANS/ITEM

PER CASE

PACKAGING

UNIT OF

MEASURE

RATE PER

UNIT

Ensure Clear

B4102:BO

250

24

Bottle

1 UNIT = 500ML

$ 1.00

Boost Breeze

B4102:BO

250

24

Bottle

1 UNIT = 500ML

$ 1.25

Boost Soothe

B4102:BO

250

24

Bottle

1 UNIT = 500ML

$2.60

Pedialyte

B4103:BO

1000

8

Bottle

1 UNIT = 500ML

$ 5.33

ReSource Benefiber

B4104:BO

25 per scoop

.

(248 g cans)

.

$ 35.00

Ensure

B4150:BO

250

24

24

1 UNIT = 100 CALORIES

$ 0.60

Jevity 1.2 Cal

B4150:BO

285

24

Bottle

1 UNIT = 100 CALORIES

$ 0.60

Osmolite 1.2 Cal

B4150:BO

285

24

Bottle

1 UNIT = 100 CALORIES

$ 0.60

Boost Very High Calorie (VHC)

B4152:BO

530

24

Bottle

1 UNIT = 100 CALORIES

$ 0.49

Ensure Plus

B4152:BO

350

24

Bottle

1 UNIT = 100 CALORIES

$ 0.49

Hi-Cal

B4152:BO

2000

8

Bottle

1 UNIT = 100 CALORIES

$ 0.49

TwoCal HN

B4152:BO

475

24

Bottle

1 UNIT = 100 CALORIES

$ 0.49

Kate Farms Peptide 1.0

B4153:BO

325

12

Bottle

1 UNIT = 100 CALORIES

$ 6.00

Kate Farms Peptide 1.5

B4153:BO

500

12

Bottle

1 UNIT = 100 CALORIES

$ 5.64

Peptamen

B4153:BO

250

24

Bottle

1 UNIT = 100 CALORIES

$ 3.60

Peptamen 1.5

B4153:BO

375

24

Bottle

1 UNIT = 100 CALORIES

$ 3.53

Glucerna 1.0 Cal

B4154:BO

237

24

Bottle

1 UNIT = 100 CALORIES

$ 1.06

Glucerna 1.2 Cal

B4154:BO

285

24

Bottle

1 UNIT = 100 CALORIES

$ 1.06

Glucerna 1.5

B4154:BO

356

24

Bottle

1 UNIT = 100 CALORIES

$ 1.06

Glucerna Shake

B4154:BO

190

24

Bottle

1 UNIT = 100 CALORIES

$ 1.06

Nepro

B4154:BO

420

24

Bottle

1 UNIT = 100 CALORIES

$ 1.06

Novasource Renal

B4154:BO

475

24

Bottle

1 UNIT = 100 CALORIES

$1.06

LiquaCel Liquid Protein (32 oz bottles)

B4155:BO

3200

32 oz bottle

Bottle

1 UNIT = 100 CALORIES

$ 1.18

Simply Thick (indiv service pkts)

B4100

1.1 oz/pkt (thickens 4oz)

80

(pkts/case)

$ .96

Simply Thick-Honey (indiv service pkts)

B4100

1.1 oz/pkt (thickens 4oz)

100

(pkts/case)

$ 1.10

Thick-It

B4100

221 Tablespoons

1

(36oz can)

$ 25.00