Find Your Product
Product Details
Incontinence PULL-UPS
- All incontinence orders require Prior Authorization through Title 19.
- Our staff will gather the necessary paperwork for Prior Authorization.
- If Title 19 denies the requested order, we will contact the Case Manager to submit the order to Advantage Waiver for approval.
- You’ll receive updates in Harmony on our progress.
- For additional quantities, the case manager will add the overage to the member’s Advantage service plan.
HCPCS: T4525
PV511Moderate
Small (20” to 34”) | Pack of 22
Medicaid/Title 19: $0.86 Each
Advantage: $0.86 Each
HCPCS: T4526
PF512Moderate
Medium (34” to 46”) | Pack of 20
Medicaid/Title 19: $1.01 Each
Advantage: $1.01 Each
HCPCS: T4526
PVS512Super
Medium (34” to 46”) | Pack of 18
Medicaid/Title 19: $1.01 Each
Advantage: $1.01 Each
HCPCS: T4527
PVS513Super
Large (44” to 54”) | Pack of 16 ($ 1.10 Each.)
Medicaid/Title 19: $1.10 Each
Advantage: $1.10 Each
HCPCS: T4528
PF514Moderate
XLarge (48” to 68”) | Pack of 14 ($ 1.25 Each.)
Medicaid/Title 19: $1.25 Each
Advantage: $1.25 Each
HCPCS: T4544
PV517Bariatric Super
XXL (68” to 80”) | Pack of 12 ($ 2.02 Each)
Medicaid/Title 19: *Manually Priced
Advantage: $2.25 Each
Incontinence PADS
- All incontinence orders require Prior Authorization through Title 19.
- Our staff will gather the necessary paperwork for Prior Authorization.
- If Title 19 denies the requested order, we will contact the Case Manager to submit the order to Advantage Waiver for approval.
- You’ll receive updates in Harmony on our progress.
- For additional quantities, the case manager will add the overage to the member’s Advantage service plan.
HCPCS: T4535
PV930First Quality Pads
Light (9.25” Length) | Pack of 30 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
BC012First Quality Pads
Regular (9.25” Length) | Pack of 20 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
19564Poise Pads
Moderate (3.0” X 9.5”) | Pack of 20 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
BC013First Quality Pads
Moderate (4.0” X 11.00”) | Pack of 16 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
PV811MALE Incontinent Pads
Moderate (13” long ) | Pack of 14 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
PV9231First Quality Pads
Super 16” length) | Pack of 33 ($ 0.59 Each)
Medicaid/Title 19: $0.59 Each
Advantage: $0.59 Each
HCPCS: T4535
1711310Belted Undergarment One Size
Pack of 10 ($ 0.59 ea.)
Medicaid/Title 19: $0.59 EA
Advantage: $0.59 EA
Incontinence BRIEFS
HCPCS: T4522
PF012BGModerate
Medium (32” to 44”) | Pack of 20 ($ 0.85 ea)
Medicaid/Title 19: $0.85 Each
Advantage: $0.85 Each
HCPCS: T4523
NUFIT013Moderate
Large (45” to 58”) | Pack of 18 ($ 0.96 ea)
Medicaid/Title 19: $0.96 Each
Advantage: $0.96 Each
HCPCS: T4523
0132BGModerate
Large (45” to 58”) | Pack of 18 ($ 0.96 ea)
Medicaid/Title 19: $0.96 Each
Advantage: $0.96 Each
HCPCS: T4524
PF0141BGModerate
XLarge (59” to 64”) | Pack of 15 ($ 1.13 ea)
Medicaid/Title 19: $1.13 Each
Advantage: $1.13 Each
HCPCS: T4543
PV017Moderate
XXLarge (62” to 73”) - Size A | Pack of 12 ($ 2.02)
Medicaid/Title 19: Manually Priced
Advantage: $2.25 Each
HCPCS: T4543
PV097Bariatric Moderate
XXXLarge (Up to 94”) - Size B | Pack of 10 ($ 2.25)
Medicaid/Title 19: Manually Priced
Advantage: $2.25 Each
Incontinence UNDERPADS
HCPCS: T4542
UP150Disposable Underpad 23 X 36”
Pack of 15 ($ 0.38 ea)
Medicaid/Title 19: $.038EA
Advantage: $.038 EA
HCPCS: T2028
988B12Breathable Underpads 30’ x 30’
Pack of 12 988B6
Medicaid/Title 19: $1.50 Each
Advantage: $1.50 Each
HCPCS: T4541
UP100Disposable Underpad 30” X 30”
Pack of 10 ($ 0.58 ea)
Medicaid/Title 19: $0.58 EA
Advantage: $0.58 EA
HCPCS: T4541
UFPP360Disposable Underpad 30” X 36”
Pack of 10 ($ 0.58 ea)
Medicaid/Title 19: $0.58 EA
Advantage: $0.58 EA
HCPCS: T4540
71188600Chair Size Washable Underpads
18” X 24” (each)
Medicaid/Title 19: $14.40 Each
Advantage: $14.40 Each
HCPCS: T4537
63178601Washable Underpad
34” X 35” (each)
Medicaid/Title 19: $13.50 Each
Advantage: $13.50 Each
BATHROOM SAFETY
HCPCS: S5165: TF
Hand Held Shower, Installed$90.00 EACH
Use a TF Modifer
HCPCS: S5165: TF
Raised Toilet Seat Without Arms, 250 lbs. Capacity$80.00 EACH
Use a TF Modifier
HCPCS: S5165: TF
Raised Toilet Seat With Arms, 250 lbs. Capacity$100.00 EACH
Use a TF Modifer
HCPCS: S5165: TF
Toilet Safety Frame, 250 lbs. Capacity$90.00 EACH
Use a TF Modifer
HCPCS: E0240
Shower StoolSeat Dimensions: 12.5d x 12.75w
Seat Height: 15.5 inch - 20.5 inch
Weight Capacity: 300 lbs.
Medicaid/Title 19: $60.00 EACH
Needs: RX, Medical Records & PA learn_more
HCPCS: E0240
Shower Chair Without BackSeat Dimensions: 19.25" (W) x 11.5" (D)
Weight Capacity: 300 lb.
Medicaid/Title 19: $70.00 EACH
Needs: RX, Medical Records & PA
HCPCS: E0240
Shower Chair With BackSeat Dimensions: 19.25" (W) x 11.5" (D)
Weight Capacity: 300 lbs
Medicaid/Title 19: $75.00 EACH
Needs: RX, Medical Records & PA
HCPCS: E0240
Heavy Duty Shower Chair Without BackSeat Dimensions: 20" (W) x 12” (D)
Seat To Floor Height: 14"-19"
Weight Capacity: 500 lbs
Medicaid/Title 19: $95.00 EACH
Needs: RX, Medical Records & PA
HCPCS: E0240
Heavy Duty Shower Chair With BackSeat Dimensions: 20” (W) x 12” (D)
Seat Height: 14 Inch - 19 Inch
Weight Capacity: 500 lbs
Medicaid/Title 19: $125.00 EACH
Needs: RX, Medical Records & PA
HCPCS: E0247
Tub Transfer BenchSeat Dimensions: 26" (W) x 18.5" - 19.5" (D)
Weight Capacity: 400 lb.
Medicaid/Title 19: $125.00 EACH
Needs: RX, Medical Records & PA
HCPCS: E0248
Heavy Duty Tub Transfer BenchSeat Dimensions: 26.5" (W) x 16.5" (D)
Weight Capacity: 500 lb
Medicaid/Title 19: $160.00 EACH
Needs: RX, Medical Records & PA
HCPCS: S5165: TF
Bathtub Mounted Grab BarWeight Capacity: 300 lbs.
$75.00 EACH
Use a TF Modifer
HCPCS: S5165: TF
Grab Bar Wall Mount, 350 lbs. Capacity, InstalledSizes; 12”, 16”, 18”, 24”, 32”
$150.00 EACH
Use a TF Modifer
AIDS TO DAILY LIVING
HCPCS: A4670
Blood Pressure Monitor
$95.00
HCPCS: T1505
Automatic Alarmed Pill Dispenser
$125.00
HCPCS: E0274
Overbed Table
Medicaid/Title 19: $150.00
HCPCS: E0705
Transfer Device - Gait Belt
Medicaid/Title 19: $28.50
HCPCS: A4927
- Gloves (only with incontinence order)
- Two Boxes Per Month May be Authorized for those receiving PCA Services
- Needs: RX, Medical Records.
- PA Required
- Advantage: $10.00
HCPCS: E1399
- Adaptive Utensils – Universal Size & Set
- (Curved and Weighted available)
- Needs: RX, Medical Records.
- No PA Required
- Advantage: $68.00
HCPCS: A9281
- Hip Kit – Includes: 32” or 26”
- Reacher, sock aid w/ foam handle, plastic 16 1/4” shoehorn, bendable 18” handled bathing sponge.
- Needs: RX, Medical Records.
- No PA Required
- Advantage: $62.50
HCPCS: A9281
- Comfort Hygiene Wipe
- Needs: RX, Medical Records.
- No PA Required
- Advantage: $28.00
HCPCS: A9281
Sock Aid
Needs: RX, Medical Records. No PA Required
Advantage: $24.50
HCPCS: A9281
Reacher - 26” or 32”
Needs: RX, Medical Records. No PA Required
Advantage: $35.00
Nutritional Products
No products found for this category.
PERSONAL EMERGENCY RESPONSE SYSTEM
- iMed Alert Systems must be chosen for this item.
- Service Plan Provider must be listed as iMed Alert Systems.
- Please tag all Harmony Notes to Evan McCown.
- All units are GPS enabled!
- These units can be used anywhere your member goes!
- Find out how to get a Personal Emergency Response System approved for your members safety
- QUESTIONS? CALL US.405-799-8855
HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00
Belle LTE Pendant
30 Day Battery Life
Verizon 4G LTE
Water Resistant (IP67)
WiFi/Cellular Location Tracking
HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00
Brighton Smart Watch
24 Hour Battery Life
AT&T 4G LTE
Water Resistant (IP67)
GPS/WiFi Location Tracking
Fall Detection optional
Monitors Heart Rate, Steps, & Weather
HCPCS: E1399
Lock Box/Key Safe
Advantage: $25.00
HCPCS: S5161
GPS Cellular Unit /Monthly Monitoring
Advantage: $35.00
HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00
Belle W Wristband
6 Day Battery Life Verizon 4G LTE
Water Resistant (IP67)
WiFi Location Tracking
Fall Detection Optional
Battery Life: 45 Days
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 | $ 10.75 |
ReSource Benefiber | B4104:BO | 25 per scoop | . | (248 g cans) | . | $ 30.00 |
Ensure | B4150:BO | 250 | 24 | 24 | 1 UNIT = 100 CALORIES | $ 0.59 |
Jevity 1.0 Cal | B4150:BO | 250 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.59 |
Jevity 1.2 Cal | B4150:BO | 285 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.59 |
Osmolite 1.2 Cal | B4150:BO | 285 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.59 |
Boost Very High Calorie (VHC) | B4152:BO | 530 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
Ensure Plus | B4152:BO | 350 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
Hi-Cal | B4152:BO | 2000 | 8 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
IsoSource 1.5 Cal | B4152:BO | 375 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
Jevity 1.5 Cal | B4152:BO | 355 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
Osmolite 1.5 Cal | B4152:BO | 355 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
TwoCal HN | B4152:BO | 475 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 0.48 |
Kate Farms Peptide 1.0 | B4153:BO | 325 | 12 | Bottle | 1 UNIT = 100 CALORIES | $ 4.00 |
Kate Farms Peptide 1.5 | B4153:BO | 500 | 12 | Bottle | 1 UNIT = 100 CALORIES | $ 3.75 |
Peptamen | B4153:BO | 250 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 5.60 |
Peptamen 1.5 | B4153:BO | 375 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 20.25 |
Glucerna 1.0 Cal | B4154:BO | 237 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 1.03 |
Glucerna 1.2 Cal | B4154:BO | 285 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 1.03 |
Glucerna 1.5 | B4154:BO | 356 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 1.03 |
Glucerna Shake | B4154:BO | 190 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 1.03 |
Nepro | B4154:BO | 420 | 24 | Bottle | 1 UNIT = 100 CALORIES | $ 1.03 |
LiquaCel Liquid Protein (32 oz bottles) | B4155:BO | 3200 | 32 oz bottle | Bottle | 1 UNIT = 100 CALORIES | $ 1.15 |
Resource Benecalorie | B4155:BO | 330 | 24 | (1.5 oz containers) | 1 UNIT = 100 CALORIES | $ 1.15 |
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 |
Ensure Clear
HCPCS
B4102:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
Bottle
RATE PER UNIT
$ 1.00
Boost Breeze
HCPCS
B4102:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
Bottle
RATE PER UNIT
$ 1.25
Boost Soothe
HCPCS
B4102:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
Bottle
RATE PER UNIT
$2.60
Pedialyte
HCPCS
B4103:BO
ML/CALORIES PER CAN
1000
CANS/ITEM PER CASE
8
PACKAGING
Bottle
UNIT OF MEASURE
Bottle
RATE PER UNIT
$ 10.75
ReSource Benefiber
HCPCS
B4104:BO
ML/CALORIES PER CAN
25 per scoop
CANS/ITEM PER CASE
.
PACKAGING
(248 g cans)
UNIT OF MEASURE
.
RATE PER UNIT
$ 30.00
Ensure
HCPCS
B4150:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
24
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.59
Jevity 1.0 Cal
HCPCS
B4150:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.59
Jevity 1.2 Cal
HCPCS
B4150:BO
ML/CALORIES PER CAN
285
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.59
Osmolite 1.2 Cal
HCPCS
B4150:BO
ML/CALORIES PER CAN
285
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.59
Boost Very High Calorie (VHC)
HCPCS
B4152:BO
ML/CALORIES PER CAN
530
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
Ensure Plus
HCPCS
B4152:BO
ML/CALORIES PER CAN
350
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
Hi-Cal
HCPCS
B4152:BO
ML/CALORIES PER CAN
2000
CANS/ITEM PER CASE
8
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
IsoSource 1.5 Cal
HCPCS
B4152:BO
ML/CALORIES PER CAN
375
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
Jevity 1.5 Cal
HCPCS
B4152:BO
ML/CALORIES PER CAN
355
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
Osmolite 1.5 Cal
HCPCS
B4152:BO
ML/CALORIES PER CAN
355
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
TwoCal HN
HCPCS
B4152:BO
ML/CALORIES PER CAN
475
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 0.48
Kate Farms Peptide 1.0
HCPCS
B4153:BO
ML/CALORIES PER CAN
325
CANS/ITEM PER CASE
12
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 4.00
Kate Farms Peptide 1.5
HCPCS
B4153:BO
ML/CALORIES PER CAN
500
CANS/ITEM PER CASE
12
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 3.75
Peptamen
HCPCS
B4153:BO
ML/CALORIES PER CAN
250
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 5.60
Peptamen 1.5
HCPCS
B4153:BO
ML/CALORIES PER CAN
375
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 20.25
Glucerna 1.0 Cal
HCPCS
B4154:BO
ML/CALORIES PER CAN
237
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.03
Glucerna 1.2 Cal
HCPCS
B4154:BO
ML/CALORIES PER CAN
285
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.03
Glucerna 1.5
HCPCS
B4154:BO
ML/CALORIES PER CAN
356
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.03
Glucerna Shake
HCPCS
B4154:BO
ML/CALORIES PER CAN
190
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.03
Nepro
HCPCS
B4154:BO
ML/CALORIES PER CAN
420
CANS/ITEM PER CASE
24
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.03
LiquaCel Liquid Protein (32 oz bottles)
HCPCS
B4155:BO
ML/CALORIES PER CAN
3200
CANS/ITEM PER CASE
32 oz bottle
PACKAGING
Bottle
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.15
Resource Benecalorie
HCPCS
B4155:BO
ML/CALORIES PER CAN
330
CANS/ITEM PER CASE
24
PACKAGING
(1.5 oz containers)
UNIT OF MEASURE
1 UNIT = 100 CALORIES
RATE PER UNIT
$ 1.15
Simply Thick-Honey (indiv service pkts)
HCPCS
B4100
ML/CALORIES PER CAN
1.1 oz/pkt (thickens 4oz)
CANS/ITEM PER CASE
100
PACKAGING
(pkts/case)
UNIT OF MEASURE
RATE PER UNIT
$ 1.10
Thick-It
HCPCS
B4100
ML/CALORIES PER CAN
221 Tablespoons
CANS/ITEM PER CASE
1
PACKAGING
(36oz can)
UNIT OF MEASURE
RATE PER UNIT
$ 25.00
What To Expect With Your Order!
- A trained technician contacts the member to gather essential information for proper programming of the iMed Alert System.
- We work with our monitoring company to test, charge, and prepare each unit for immediate use.
- Once ready, the device is shipped directly to the member. NOTE: Modern GPS-enabled units require no invasive installation, unlike older 3G models.
- Upon delivery, the member is instructed to contact us for a walkthrough on charging, testing, and operating their device.