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Common Formula Package Maximums (FFY 2017)

Updated January 2017 of 15

Fully Formula Fed (FFF) Infant Max

Infant Age @ First Day To Use* Child

Max**

Woman

Max** 0-3 m 4-5 m

6-11 m

w/food

6-11 m

No food

Max Ounces Per Day

Powder

Concentrate

Ready to Feed

29 oz

27.4 oz

28.1 oz

32 oz

29.8 oz

30.4 oz

23.2 oz

21 oz

21.4 oz

32 oz

29.8 oz

30.4 oz

30.3 oz 30.3 oz

Max Ounces Per Month Powder

Concentrate

Ready to Feed

870 oz 823 oz

832 oz

960 oz 896 oz

913 oz

696 oz 630 oz

643 oz

960 oz 896 oz

913 oz

910 oz 910 oz

Full Nutritional Benefit 806 oz 884 oz 624 oz 884 oz

* Fully formula fed infants always receive the maximum amount of formula allowed for age. This amount must be no less than the

full nutritional benefit and no greater than the maximum amount for age.

** Amount needed per day will be issued based on the amount requested on the Medical Documentation Form 1, but not to exceed the

maximum allowed.

Formula Company

Form Package

Size

Reconstitute

Amount Containers/

Case Flavors Fully Formula Fed (FFF) Infant Max

Infant Age @ First Day To Use

Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Alfamino Infant State Order Only

Nestlé Powder 14.1 oz.

(400 g)

96 oz. 6 cans N/A 9 10 7 10 9 ---

Alfamino Junior State Order Only

Nestlé Powder 14.1 oz. (400 g)

62 oz. 6 cans Unflavored --- --- --- --- 14 ---

Benecalorie K

See Supplemental Formula Conversion Table for Amount of Formula Replaced

State Order Only

Nestlé RTF 1.5oz 1.5oz 24 cups Unflavored --- --- --- 606 606

Beneprotein K

(1 scoop = 1 packet) See Supplemental Formula

Conversion Table for Amount of Formula Replaced

State Order Only

Nestlé Powder

8 oz

(227 g)

NSD* 6 cans Unflavored --- --- --- --- 18 18

7 g NSD* 75 packets Unflavored --- --- --- --- 583 583

Boost Kid Essentials,

retail version K

Nestlé RTF 8.25 oz 8.25 oz 16 prisms

(4-4 packs)

Vanilla --- --- --- --- 110 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Boost Kid Essentials

1.0 K

Nestlé RTF 8 oz 8 oz 27 briks Chocolate

Strawberry Vanilla

--- --- --- --- 113 ---


1.5 K

Nestlé RTF 8 oz 8 oz 27 briks Chocolate

Strawberry Vanilla

--- --- --- --- 113 ---


1.5 w/fiber K

Nestlé RTF 8 oz 8 oz 27 briks Vanilla --- --- --- --- 113 ---

Boost Breeze (formerly

Resource Breeze) H K

Nestlé RTF 8 oz 8 oz 27 cartons Orange Peach

Wild Berry Variety

--- --- --- --- 113 113

Boost Nutritional

Pudding K

State Order Only

Nestlé RTF 150 mL

5 oz 4 cans Chocolate

Very Vanilla --- --- --- --- 182 182

Boost Plus K

State Order Only

Nestlé RTF 8 oz. 8 oz 27 cartons Chocolate Strawberry

Vanilla

--- --- --- --- 113 113

Bright Beginnings Soy

Pediatric Drink K

State Order Only

PBM

Products

RTF 8 oz 8 oz 24 cans Vanilla --- --- --- --- 113 ---

Calcilo XD State Order Only

**Dropship

Abbott Powder 375 g 96 oz 6 cans N/A 9 10 7 10 9 ---

Carnation Breakfast

Essentials K

Nestlé RTF 237 mL 8 oz 24 cartons Chocolate

Strawberry Vanilla

--- --- --- --- 113 113

Compleat (Modified) State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cartons Unflavored --- --- --- --- 107 ---

Compleat Pediatric Nestlé RTF 250 mL 8.45 oz 24 cartons Unflavored --- --- --- --- 107 ---

Compleat Pediatric

Reduced Calorie State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Complete Amino Acid

Mix See Supplemental Formula Conversion Table for Amount of Formula Replaced

State Order Only **Drop Ship

Nutricia Powder 7 oz

(200 g)

NSD* 6 cans N/A --- --- --- --- --- ---

Cyclinex-1 H

State Order Only Abbott Powder 14.1 oz

(400 g)

NSD* 6 cans Unflavored 9 10 7 10 10 10

Cyclinex-2 H

State Order Only

Abbott Powder 14.1 oz

(400 g)


Duocal See Supplemental Formula Conversion Table for Amount of Formula Replaced

State Order Only

Nutricia Powder 400 g

(14 oz)

NSD* Order

Single cans

Unflavored --- --- --- --- --- ---

EleCare for Infants H

(DHA/ARA)

Abbott Powder 400 g (14.1 oz)

95 oz 6 cans N/A 9 10 7 10 9 ---

EleCare Jr. H Abbott Powder 400 g

(14.1 oz) 62 oz 6 cans Unflavored

Vanilla

--- --- --- --- 14 ---

Enfamil AR *NOT FP III

**Drop Ship (8oz RTF)

Mead Johnson

Powder 12.9 oz 91 oz Single can N/A 9 10 7 10 10 ---

RTF 32 oz 32 oz 6 cans N/A 26 28 20 28 28 ---

RTF 8 oz 8 oz 24 bottles N/A 104 114 80 114 113 ---

RTF 2 oz 2 oz 48 nursettes N/A 416 456 321 456 455 ---

Enfamil EnfaCare (32 oz. RTF discontinued 4/2016)

**Drop Ship (2 oz. RTF)

Mead

Johnson

Powder 12.8 oz 82 oz 6 cans N/A 10 11 8 11 11 ---



Enfamil Human Milk

Fortifier Acidified

Liquid Order Rxed amount

only (Not exceeding the max)

State Order Only

**Drop Ship

Mead

Johnson

Liquid 5 ml vial NSD* 100 (5ml

vials) per

case – Only

ships in 2 case qty.

N/A MBF 1029

MBF

1135 MBF

823 MBF

1135

--- ---

Enfamil Premature 20,

24, 30 State Order Only (30 cal) **Drop Ship

Mead

Johnson




Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Enfaport State Order Only

Mead

Johnson

RTF 6 oz 6 oz 24 cans N/A 138 152 107 152 151 ---

Ensure Clear K

State Order Only Abbott

Nutrition

RTF 10 oz 10 oz 12 bottles Peach Blueberry/

Pomegranate Mixed Fruit

--- --- --- --- 91 91

RTF 6.7 oz 6.7 oz 32 cartons Apple Mixed Berry

--- --- --- --- 135 135

Ensure High Protein State Order Only

Abbott

Nutrition

RTF 8 oz 8 oz 24 bottles Chocolate

Vanilla

--- --- --- --- 113 113

EO28 Splash Nutricia RTF 237 mL 8 oz 27 carton Grape

Tropical Fruit

Orange-

Pineapple

--- --- --- --- 113 ---

Gerber Extensive HA

(MDF is required) 999 food package needed

Gerber Powder 14.1 oz

(400 g)

96 oz. 6 cans N/A 9 10 7 10 9 ---

Gerber Good Start

Gentle (MDF not required) *NOT FP III

Gerber Powder 12.7 oz 90 oz. 6 cans N/A 9 10 7 10 10 ---

Conc. 12.1 oz

24.2 oz. 12 cartons (3-4 packs)

N/A 34 37 26 37 37 ---

RTF 33.8 oz

(4-8 oz)

33.8 16 (4-4

tetrapacks)

N/A 24 27 19 27 26 ---

Gerber Good Start

Premature 24

Gerber RTF 3 oz 3 oz 48 nursettes N/A 277 304 214 304 303 ---

Gerber Good Start Soothe (MDF not required) *NOT FP III

Gerber Powder 12.4 oz 90 oz 6 cans N/A 9 10 7 10 10 ---

Gerber Good Start

Soy H K

(MDF not required) *NOT FP III

Gerber Powder 12.9 oz 91 oz 6 cans N/A 9 10 7 10 10 ---

Conc. 12.1 oz 24.2 oz 12 cartons (3-4 packs)

N/A 34 37 26 37 37 ---

RTF 33.8 oz

(4-8 oz)

33.8 16 (4-4

tetrapacks)

N/A 24 27 19 27 26 ---

Glutarex-1 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Glutarex-2 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

Glytrol K

(Formerly Nutren Glytrol)

State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 107

Hominex-1 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

Hominex-2 H


(400 g) NSD* 6 cans N/A 9 10 7 10 10 10

I-Valex-1H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

I-Valex-2 H


(400 g) NSD* 6 cans N/A 9 10 7 10 10 10

KetoCal 3:1 (Recommended child 1-8 yrs)

State Order Only


(300 g)

70 oz 6 cans N/A 12 13 9 13 13 13

KetoCal 4:1 State Order Only

**Drop Ship (Unflavored RTF)


(300 gr)

105 oz

(20 cal/oz)

6 cans Vanilla 8 9 6 9 --- ---

Powder 11 oz

(300 g)

70 oz

(30 cal/oz)

6 cans Vanilla --- --- --- --- 13

13

RTF 8 oz 8 oz 27 boxes Vanilla

Unflavored

104 114 80 114 113 113

Ketonex-1 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

Ketonex-2 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

KetoVie State Order Only

**Drop Ship

Cambrooke

Therapeutics

RTF 250 mL 8.5 oz 30 cartons Vanilla

Chocolate

--- --- --- --- 107 107

Lipistart (Recommended child 1+)

State Order Only

Vitaflo Powder 14.1 oz

(400 g)

80 oz Order single

cans

N/A 9 10 7 10 11 11

Maxamum XPhe (Not recommended child <9)

State Order Only

Nutricia Powder 16 oz NSD* 6 cans

Orange Unflavored

8 8 6 8 9 9



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Microlipids (Modular) K

See Supplemental Formula Conversion Table for Amount of Formula Replaced State Order Only

Nestlé

Nutrition

RTF 3 oz

(89ml)

NSD* 48 bottles N/A --- --- --- --- --- ---

MCT oil (Modular) K

See Supplemental Formula Conversion Table #2 for

Amount of Formula Replaced State Order Only

Nestlé Nutrition

RTF 32 oz NSD* Order single

bottles

N/A --- --- --- --- --- ---

Neocate Infant

DHA/ARA

Nutricia Powder 14.1 oz (400 g)

97 oz 4 cans N/A 8,8,9 9 7 9

9 ---

Neocate Junior (unflavored)


(400 g)

64 oz 4 cans Unflavored --- --- --- --- 14 ---

Neocate Junior (flavored)


(400 g)


Tropical

--- --- --- --- 15 ---

Neocate Junior

w/Prebiotics State Order Only


(400 g)

64 oz Order

Single cans

Unflavored

Vanilla

Strawberry

--- --- --- --- 14 ---

Neocate Nutra K H

(Order Rxed amount only - Not exceeding the max)

State Order Only

**Drop Ship

Nutricia Powder 14 oz 36 oz Order Single

Cans

Unflavored --- --- 19 26 25 ---

Neocate Splash State Order Only

Nutricia RTF 8 oz 8 oz 27 drink box Unflavored --- --- --- --- 113 ---

Neocate Syneo

Infant State Order Only

Nutricia RTF 14.1 oz 95 oz 4 cans N/A 9 10 7 10 9 ---

Nepro with Carb

Steady K (H-Butter Pecan only)

State Order Only

Abbott RTF 8 oz 8 oz 24 cans Butter Pecan

Homemade

Vanilla Mixed Berry

--- --- --- --- 113 113

Nutramigen Mead Conc. 13 oz 26 oz 12 cans N/A 31 34 24 34 35 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Johnson RTF 32 oz 32 oz 6 cans N/A 26 28 20 28 28 ---


Nutramigen w/

Enflora LGG Toddler 999 food package needed

Mead

Johnson

Powder 12.6 oz 86 oz 6 cans N/A --- --- 8 >9 mo

only

11 >9 mo

only

10 ---

Nutramigen w/

Enflora LGG

Mead Johnson

Powder 12.6 oz 87 oz Single cans N/A 10 11 8 11 10 ---

Nutren 1.0 K

State Order Only Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 107

Nutren 1.0 w/ Fiber K


Nutren 1.5 K

State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 107

Nutren 2.0 K


Nutren Junior K Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 ---

Nutren Junior Fiber K Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 ---

Nutren Pulmonary K

State Order Only Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla

Unflavored --- --- --- --- 107 107

NutriHep K

State Order Only Nestlé RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 107

Osmolite H K

State Order Only Abbott RTF 8 oz 8 oz 24 cans Unflavored --- --- --- --- 113 113

PediaSure H K Abbott RTF 8 oz 8 oz 24 bottles Banana

Berry

Chocolate

Strawberry

Vanilla

--- --- --- --- 113 ---

PediaSure with Fiber H

K

Abbott RTF 8 oz 8 oz 24 bottles Vanilla --- --- --- --- 113 ---

PediaSure Enteral 1.0

cal H K


PediaSure Enteral 1.0

cal (fiber) H K


PediaSure 1.5 Cal H K Abbott RTF 8 oz 8 oz 24 cans Vanilla --- --- --- --- 113 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

PediaSure 1.5 Cal with

Fiber H K


PediaSure Peptide 1.0

Cal H K

Abbott RTF 8 oz 8 oz 24 bottles Strawberry

Unflavored

Vanilla

--- --- --- --- 113 ---

PediaSure Peptide 1.5

Cal H K

State Order Only


Peptamen Junior Nestlé RTF 250 mL 8.45 oz 24 cans Chocolate

Strawberry

Unflavored

Vanilla

--- --- --- --- 107 ---

Peptamen Junior

Fiber

Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 ---

Peptamen Junior w/

Prebio

Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 ---

Peptamen Junior 1.5 Nestlé RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 ---

PKU Periflex Early

Years State Order Only

Nutricia Powder 400 g

(14.1 oz)

90 oz 6 cans N/A 9 10 7 10 10 ---

Periflex Infant State Order Only

Nutricia Powder 400 g (14 oz)

84 oz 6 cans N/A 10 11 8 11 10 ---

Periflex Junior State Order Only


(454 g)

57 oz 6 cans Orange --- --- --- --- 15 ---

60 oz 6 cans Unflavored

PKU Periflex Junior

Plus State Order Only

Nutricia Powder 14.1 oz 51 oz 6 cans Plain --- --- --- --- 17

Phenex-1 H


(400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

Phenex-2 H


(400 g)

NSD* 6 cans Unflavored

Vanilla

9 10 7 10 10 10

PhenylAde 60 Drink

Mix

Applied

Nutrition

Powder 16 oz

(454 g)

81 oz 4 cans Unflavored

8 8 6 8 11 11



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

(Recommended child >1 yo)

State Order Only Corp. Powder 16.7 g 3oz 30 pouches Vanilla 290 320 232 320 303 303

PhenylAde Essential

Drink Mix (Recommended child >1 yo)

State Order Only

Applied

Nutrition Corp.

Powder 16 oz

(454 g)


Orange

Crème

Strawberry

11 12 8 12 11 11

Powder 40 g

7 oz 16 pouches Vanilla 124 137 99 137 130 130

PhenylAde MTE AA

Blend State Order Only (Recommended child >1 yr.)

Applied

Nutrition Corp.

Powder 16 oz

(454 g)


Powder 12.8 g NSD* 30 pouches Unflavored 283 312 225 312 318 318

Phenyl-Free 2 HP (Recommended child > 1 yr.)

State Order Only

Mead Johnson

Powder 16 oz NSD* 6 cans N/A 8 8 6 8 9 9

Phlexy-10 Drink Mix State Order Only

Nutricia Powder 20 g 3.38 oz 30 packets Black Currant/

Apple

Tropical

Surprise

-- -- -- -- 269 269

Polycal See Supplemental Formula

Conversion Table for Amount of Formula Replaced

Nutricia Powder 14.1 oz (400 g)

NSD* 12 Unflavored --- --- --- --- --- ---

Portagen (Recommended for child > 1 yr.)

Mead

Johnson

Powder 14.4 oz 64 oz Single cans N/A 13 15 10 15 14 14

Pregestimil Mead

Johnson

Powder 1 lb 112 oz Single cans N/A 7,7,7,8 8 6 8 8 ---


Pregestimil 24 **Drop Ship

Mead Johnson


ProMod Liquid

Protein (modular: mix 1 oz (30 ml) with 1-2 oz

H2O) See Supplemental Formula Conversion Table for Amount

of Formula Replaced

State Order Only

Abbott Liquid 32 oz (946 mL)

32 oz 6 containers Fruit Punch 26 28 20 28 28 28



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Pro-Phree H

(Recommended infants & toddlers)

State Order Only

Abbott Powder 14.1 oz

(400 g)

NSD* 6 cans N/A 9 10 7 10 10 ---

Propimex-1 H

(Recommended infants &

toddlers)

State Order Only

Abbott Powder 14.1 oz (400 g)

NSD* 6 cans N/A 9 10 7 10 10 ---

Propimex-2 H

(Recommended child > 1 yr.

& adults)

State Order Only

Abbott Powder 14.1 oz (400 g)

NSD* 6 cans N/A 9 10 7 10 10 10

ProViMin H K


(150 g) NSD* 6 cans N/A 24 26 19 26 27 27

PurAmino

Mead

Johnson

Powder 14.1 oz 98 oz Order

Single cans

N/A 8,8,8,9 9 7 9 9 ---

PurAmino Toddler State Order Only

**Dropship

Mead Johnson

Powder 14.1 oz 66 oz 4 cans N.A --- --- --- --- 13 ---

RCF (Ross CHO Free) H K

State Order Only

Abbott Conc. 13 oz 26 oz 12 cans N/A 31 34 24 34 35 ---

RenalCal K Nestle RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 107

Renastart State Order Only

**Drop Ship

Vitaflo Powder 14.1 oz.

(400 g) 67.5 oz. Single Cans N/A --- --- --- --- 13 13

Replete Fiber K

(Formerly Nutren Replete Fiber)

State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 107

ScandiShake State Order Only

Aptalis Powder 3 oz (85 g)

9 oz 4 pkts Vanilla Strawberry

--- --- --- --- 101 101

Similac Alimentum (formerly Similac Expert Care Alimentum)

Abbott Powder 16 oz 115 oz 6 cans N/A 7,7,7,8 8 6 8 7 ---

Powder 12.1 oz 87 oz 6 cans N/A 10 11 8 11 10 ---


RTF 8 oz 8 oz 24 cans N/A 104 114 80 114 113 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Similac NeoSure H K

(formerly Similac Expert Care NeoSure)

Abbott

Powder 13.1 oz 87 oz Single Cans N/A 10 11 8 11 10 ---

RTF 1 qt 32 oz 6 bottles N/A 26 28 20 28 28 ---


Similac Human Milk

Fortifier H K

Order Rxed amount only (Not exceeding the max)

State Order Only

Abbott Powder 0.9 g NSD* 50

pack/carton

N/A MBF 1029

MBF 1135

MBF 823

MBF 1135

--- ---

Similac PM 60/40 H K Abbott Powder 14.1 oz 102 oz Order

Single cans

N/A 8 9 7 (6 mo)

6 (7-11

mo)

9 8 ---

Similac Special Care

20, 24, or 30 H K

State Order Only

(Special Care 30)

**Drop Ship (SC 30)

Abbott RTF 2 oz 2 oz 20 and 24

sold in 8-packs,

30 sold in

48-pack

N/A 416 456 321 456 455 ---

SolCarb See Supplemental Formula Conversion Table #2 for Amount of Formula Replaced State Order Only

**Drop Ship

Solace Powder 8 oz

(227 g)

NSD* 4 cans

N/A --- --- --- --- --- ---

Suplena with Carb

Steady H K

Abbott RTF 8 oz 8 oz 24 cans Homemade

vanilla

--- --- --- --- 113 113

Tolerex K

Not recommended for infants 0-12 mo

State Order Only

Nestlé Powder 2.82 oz

(80 g)

10.15 oz 6 pkt/

cartons

Unflavored 85

94 68

94 89 89

Tyrex-1 H

(for infants & toddlers)

State Order Only

Abbott Powder 14.1 oz NSD* 6 cans N/A 9 10 7 10 10 ---

Tyrex-2 H

(for children & adults)

State Order Only

Abbott Powder 14.1 oz NSD* 6 cans N/A 9 10 7 10 10 10

UCD Anamix Junior State Order Only

Nutricia Powder 14.1 oz

(400 g) 56 oz 6 cans Unflavored

Vanilla

--- --- --- --- 16 ---



Formula Company

Form Package

Size

Reconstitute

Amount Containers/



Child

Max

Woman

Max

0-3 m 4-5 m 6-11 m

w/food

6-11 m

No food

Vivonex Pediatric K

State Order Only

Nestlé Powder 1.7 oz 8.45 oz 36 packets 6 pkt/cartons

Unflavored --- --- --- --- 107 ---

Vivonex RTF State Order Only

Nestlé RTF 250 mL 8.45 oz 24 cartons Unflavored --- --- --- --- 107 107

Formula

Form:

Infant Maximum (if no standard dilution) Child/Woman Maximum

(if no standard dilution)

Birth- 3 months Age 4- 5 Months Age 6-11

Months

Age 6-11 Months (no

food)

Powder 128 oz / 3628 g 141 oz / 3997 g 102 oz / 2891 g 141 oz / 3997 g 144 oz / 4082 g (1 fluid ounce = 29.57 milliliters; 1 pound = 453.6 grams; 1 ounce = 28.35 grams)

Notes: NSD*= No Standard Dilution

Except for Neocate Infant and Jr., Nutricia lists their 400 g products as 14 oz; other companies list their products as 14.1 oz

K= Kosher; H= Halal

**Drop shipped items may take 4-7 business days to arrive after SWO processing.



SUPPLEMENTAL FORMULA CONVERSION TABLE - MODULARS

Displacement Method

Monthly RX Amount of Formula Replaced

Concentrate 12 - 13 oz

Powder 12 - 16 oz

Powder 22 - 24 oz

Ready to Feed 32 - 34 oz

Duocal (14.1 oz. powder) 1 can contains 48 TBSP/80 scoops/400 grams/2008 Calories

1 can 4 1 1 4

2 cans 8 2 1 7

3 cans 12 3 2 10

4 cans 16 4 2 13

SolCarb (8 oz) 1 can contains 57 TBSP/851 Calories

1 can 1 1 1 1

2 cans 2 1 1 2

3 cans 3 2 2 3

4 cans 4 2 2 4

5 cans 5 3 3 5

BeneCalorie (1.5 oz. cup) 1 cup contains 330 calories and 7 grams of protein

1-2 container(s) 1 1 1 1

3 containers 2 1 1 2

4-5 packets 3 1 1 3

6 packets 4 2 1 3

7-8 containers 5 2 1 4








19-20 containers 13 3 2 10


22-23 containers 14 4 2 12


25-26 containers 16 4 3 13


28-29 containers 18 5 3 15






Powder 12 - 16 oz

Powder 22 - 24 oz


Human Milk Fortifier

If combining this with other formula, please call the Nutrition Unit for assistance 404-657-2884

BeneProtein (8 oz can) 1 can contains 810 calories and 194 grams of protein 1 can 2 1 1 1 2 cans 3 1 1 3 3 cans 5 2 1 4 4 cans 6 2 1 5

BeneProtein (7 gm packet) 1 packet contains 25 calories and 6 grams of protein

1-30 packets 1 1 1 1 31- 50 packets 2 1 1 2 51-60 packets 3 1 1 2 61-70 packets 3 1 1 3 71-80 packets 4 1 1 3 81-90 packets 4 2 1 4 91-100 packets 5 2 1 4 101-110 packets 5 2 2 4 111-120 packets 6 3 2 5

MCT Oil (32 fl oz bottle) 1 bottle contains 960 cc/64 TBSP/7392 Calories 1 bottle 3 1 1 3 2 bottles 6 2 1 3

Microlipid (3 oz bottle) 1 bottle contains 88.7 ml/399 Calories/44 gr Fat 1-4 bottles 1 1 1 1 5-8 bottles 2 1 1 2 9-10 bottles 3 1 1 3 11-14 bottles 4 1 1 4 15-18 bottles 5 1 1 5 19-20 bottles 6 2 1 6

Complete Amino Acid Mix

1 can 1 1 1 1

2 cans 2 1 1 2

3 cans 3 1 1 3

4 cans 4 1 1 4

5 cans 5 2 1 5

6 cans 6 2 1 6

7 cans 7 2 1 7

8 cans 8 2 1 8

9 cans 9 3 2 9

ProMod (1 qt bottle) 3680 calories per bottle/32 servings/10 CHO, 7 PRO per serving 1 bottle 8 2 1 6 2 bottles 16 4 2 12 3 bottles 24 6 3 18





Powder 12 - 16 oz

Powder 22 - 24 oz


L-Arginine 1- 4 bottles 1 1 1 1

5-8 bottles 2 1 1 2

9-12 bottles 3 1 1 3

13-16 bottles 4 2 1 4

17-20 bottles 5 2 1 5

21-24 bottles 6 2 1 6

25-29 bottles 7 2 2 7

MCT Procal (480g tub) 3150 calories per tub/30–2 scoop serving/10 gr MCT, 2 gr PRO, 105 cal per serving

1 tub 6 1 1 6

2 tub 12 3 2 12

3 tub 18 5 3 18

MCT Procal (16 gr packet) 10 gr MCT, 2 gr PRO, 105 cal per packet

0-5 packets 1 1 1 1

6-10 packets 2 1 1 2

11-15 packets 3 1 1 2

16-20 packets 4 1 1 3

21-25 packets 5 1 1 4

26-30 packets 6 1 1 5

31-35 packets 7 2 1 6

36-40 packets 8 2 1 7

41-45 packets 9 2 1 7

46-50 packets 10 2 1 8

51-55 packets 11 2 1 9

56-60 packets 12 3 2 10

61-65 packets 13 3 2 11

66-70 packets 14 3 2 12

71-75 packets 15 4 2 12

75-80 packets 16 4 2 13

81-85 packets 17 4 2 14

86-90 packets 18 5 3 15

Polycal (14.1 oz powder) 1 can contains 80 scoops/1536 Calories

1 can 4 1 1 4

2 cans 8 2 1 7

3 cans 12 3 2 10

4 cans 16 4 2 13

This institution is an equal opportunity provider.

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