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Polymeric; Standard Volume | Polymeric; Concentrated Volume | Hydrolyzed; Standard Volume

Hydrolyzed; Concentrated Volume | Elemental | Blenderized

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Polymeric; Standard Volume

Composition  Formula Brand Name, Manufacturer Specifics HCPCS code  Additional Details
Milk Based Boost® Kid Essentials 1.0 Retail, Nestlé does not contact soy ingredients B4158 Gluten-free, kosher, lactose
Milk Based Boost® Kid Essentails 1.0 Instutional, Nestlé does not contact soy ingredients B4158 Gluten-free, kosher, lactose
Milk based PediaSure® Reduced Calorie, Abbott Gluten free, reduced calorie B4160 Gluten Free, Lactose intolerance
Milk and Soy Protein  PediaSure® Enteral Formula 1.0 Cal, Abbott contains soy B4160 Gluten-free, halal, kosher, kosher made with dairy ingredients, suitable for lactose intolerance
Milk and Soy Protein  PediaSure® Enteral Formula 1.0 Cal with Fiber, Abbott contains soy B4160 Gluten-free, halal, kosher, kosher made with dairy ingredients, suitable for lactose intolerance
Milk and Soy Protein  PediaSure® Grow & Gain Therapeutic Nutrition Shake, Abbott contains soy B4160 Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein  PediaSure® Grow & Gain with Fiber Therapeutic Nutrition Shake, Abbott contains soy B4160 Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein PediaSure® Grow & Gain with Fiber, Abbott Contains soy B4159 Gluten-free, halal, kosher, suitable for lactose intolerance
Organic Pea Protein  Pediatric Standard 1.2, Kate Farms® Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber B4160 Gluten-free, lactose free, kosher, NON GMO 
Whey Protein Nutren Junior®, Nestlé Contains soy B4160 Gluten-free, lactose, kosher
Whey Protein Nutren Junior® Fiber, Nestlé Contains soy B4160 Gluten-free, lactose, kosher
Food ingredients (chicken, milk, pea protein) Compleat® Pediatric, Nestlé No soy, no corn B4149 Gluten-free, lactose, Non GMO ingredients
Food Ingredients Compleat® Pediatric Reduced Calorie, Nestlé No soy, no corn B4149 Gluten-free, lactose, Non GMO ingredients
Food  Ingredients Compleat® Pediatric Original 1.0, Nestlé Non-GMO, no corn or soy, soluble and insolulble fiber B4149 Gluten-free, suitable for lactose intolerance
Food Ingredients Compleat® Pediatric Standard 1.0, Nestlé Non-GMO, no dairy, soy, corn, nut B4160 Dairy, lactose, gluten free, plant-based, vegan, kosher

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Polymeric; Concentrated Volume

Composition  Formula Brand Name Specifics HCPCS code  Additional Details
Milk Based Boost® Kid EssentialsTM 1.5, Nestlé Contains soy B4160 Gluten-free, kosher, lactose
Milk Based Boost® Kid EssentialsTM 1.5  with Fiber, Nestlé Contains soy B4160 Gluten-free, kosher, lactose
Milk Protein Pediasure® 1.5 Cal, Abbott Contains soy B4160 Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein PediaSure® 1.5 Cal with Fiber, Abbott Contains soy B4160 Gluten-free, halal, kosher, suitable for lactose intolerance
Organic Pea Protein Standard 1.4, Kate Farms® Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber B4160 Gluten-free, lactose, kosher, NON GMO 
Pea Protein Isolate Compleat® Pediatric Standard 1.4, Nestlé Plant based, vegan. L-Cystine is added. Prebiotic Fiber (PHGG), pea fiber.   B4160 gluten free, vegan, plant based, lactose free, kosher

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Hydrolyzed; Standard Volume

Composition  Formula Brand Name Specifics HCPCS code  Additional Details
Whey Protein Peptamen Junior®, Nestlé 60% of fat from MCT, hydrolyzed whey  B4161 Gluten-free, suitable for lactose intolerant, kosher, not suitable for galactosemia or cow's milk protein allergy
Organic Pea Protein with added L-Cysteine and L-Tryptophan Pediatric Peptide 1.0®, Kate Farms® Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber B4161 Gluten-free, suitable for lactose intolerance, kosher
Whey Protein Peptamen Junior® HP, Nestlé high protein, with partially hydrolyzed soluble fiber  B4161 Gluten-free, suitable for lactose intolerance,  not for individuals with galactosemia or cow's milk protein allergy
Whey Protein Peptamen Junior® Fiber, Nestlé 1.0kcal/mL,  with 4g/L partially hydrolyzed soluble fiber and 4g/L insoluble fiber B4161 Gluten-free, lactose, not appropropriate for cow milk protein allergy, not appropriate for galactosemia
Whey Protein Peptamen Jr  PHGG, Nestlé 1.2kcal/mL, contains milk protein, 12g/L plant based prebiotic fiber is from partially hydrolyzed guar gum (PHGG) B4161 Gluten-free, suitable for lactose intolerance, not for individuals with galactosemia
Whey Protein hydrolysate and hydrolyzed sodium caseinate PediaSure® Peptide 1.0 Cal Institutional-Retail (237mL), Abbott hydrolyzed whey, Prebiotics from Nutraflora® scFOS®, DHA (32 mg per 8 fl oz) and lutein B4161 Gluten-free, halal, kosher, suitable for lactose intolerance, not for galactosemia

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Hydrolyzed; Concentrated Volume

Composition  Formula Brand Name Specifics HCPCS code  Additional Details
Whey Protein Peptamen Junior® 1.5, Nestlé Not appropriate for cow milk protein allergy, with 6 g/L partially hydrolyzed soluble  fiber B4161 Gluten-free, lactose, kosher, not for galactosemia
Whey Protein/Casein PediaSure® Peptide 1.5 Cal, Abbott with fiber (5 g/L with 4.6g of fiber from scFOS), 32mg DHA per 8oz B4161 Gluten-free, halal, kosher, suitable for lactose intolerance, not for galactosemia
Organic Pea Protein Pediatric Peptide 1.5®, Kate Farms® Vegan, no milk, no soy, no gluten, no nuts, no corn, no eggs, no fish, no shellfish, no wheat, no sesame with 20 g/L fiber B4161 Gluten-free, lactose, kosher
Pea Protein, added L-cystine, Food Ingredients Compleat® Pediatric Peptide 1.5, Nestlé Plant-based and non-GMO* Ingredients; no dairy, soy, nut or other common food allergens; no corn ingredients. Contains prebiotic fiber PHGG B4161 gluten free, vegan, plant based, lactose free, kosher

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Elemental

Composition  Formula Brand Name Specifics HCPCS code  Additional Details
Free Amino Acid EleCare® Jr, Abbott No milk, no soy, no fructose, no galactose, clinically documented hypoallergenic B4161 Gluten-free, halal, suitable for lactose intolerance, kosher, vanilla flavor contains phenylalanine
Free Amino Acid PurAmino Jr, Mead Johnson  hypoallergenic, 100% free amino acids. Contains soy oil. Contains DHA. B4161 lactose-free, kosher, halal, non-GMO
Free Amino Acid Alfamino® Junior, Nestlé nutritoinally complete, hypoallergenic formula. 65% of fat as MCT. Contains soy oil.  B4161 Gluten-free, lactose
Free Amino Acid Vivonex® Pediatric, Nestlé nutritionally complete, hypoallergenic formula, 70% of fat from MCT, contains soy oil.  B4161 Gluten-free, kosher, lactose
Free Amino Acid Neocate® Junior: Unflavored without prebiotics, Nutricia No dairy, no soy oil, hypoallergenic, no fiber B4161 Kosher
Free Amino Acid Neocate® Junior with Probiotics, Nutricia No dairy, no soy oil, hypoallergenic, contains prebiotic fiber B4161 Kosher
Free Amino Acid Neocate® Splash, Nutricia Ready to feed, sterile. No dairy, no soy oil, no casein, hypoallergenic B4161 Kosher, gluten free, lactose free
Free Amino Acid EquaCare Jr, Ajinmoto / Cambrooke  "same nutritional profile as Elecare Jr" B4161
Free Amino Acid Essential Care Jr, Ajinmoto / Cambrooke  No Milk, Lactose, Wheat, Gluten, Eggs, Nuts, Soy or Corn, includes DHA &  Lutein, no corn syrup, low FODMAP ingredients B4161

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Blenderized

Composition  Formula Brand Name Specifics HCPCS code  Additional Details
Food Ingredients Compleat® Pediatric Organic Blends (chicken garden blend), Nestlé Organic, non-GMO, no dairy, soy, corn, fortified with a vitamin/mineral to be complete nutrition   B4149 Gluten-free, lactose
Food Ingredients Compleat® Pediatric Organic Blends (plant based), Nestlé Organic, non-GMO, no dairy, soy, corn, fortified with a vitamin/mineral to be complete nutrition  B4149 Gluten-free, lactose, vegan
Food Ingredients Compleat® Pediatric Original Reduced Calorie 0.6, Nestlé Reduced calorie, non-GMO, no corn or soy, soluble and insolulble fiber B4149 Gluten-free, suitable for lactose intolerance
Food Ingredients Compleat® Pediatric Original 1.0, Nestlé Non-GMO, no corn or soy, soluble and insolulble fiber B4149 Gluten-free, suitable for lactose intolerance
Food Ingredients Compleat® Pediatric Standard 1.0, Nestlé Non-GMO, no dairy, soy, corn, nut B4160 Dairy, lactose, gluten free, plant-based, vegan, kosher
Food Ingredients Compleat® Pediatric Standard 1.4, Nestlé Non-GMO, no dairy, soy, corn, nut B4160 Dairy, lactose, gluten free, plant-based, vegan, kosher
Food Ingredients Nourish, Functional Formularies® Organic, vegan, no dairy, no nuts, no soy, no corn B4149 Gluten-free, lactose
Food Ingredients PediaSure Harvest®, Abbott No milk, gluten, lactose, eggs, treenuts, peanuts, wheat, shellfish, or fish-containing ingredients, contains soy B4149 Gluten-free, suitable for lactose intolerance
Food Ingredients Pediatric Blended Meals -Mango and Straw, Kate Farms® No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame Gluten-free, lactose-free, plant-based, vegan
Food Ingredients Pediatric Blended Meals - Squash and Carrot, Kate Farms® No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame Gluten-free, lactose-free, plant-based, vegan
Food Ingredients Pediatric Blended Meals - Banana and Blue, Kate Farms® No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame Gluten-free, lactose-free, plant-based, vegan
Food Ingredients Real Food Blends® -Orange Chicken, Carrots, and Brown Rice, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149
Food Ingredients Real Food Blends® - Salmon, Oats, and Squash, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149 Gluten Free
Food Ingredients Real Food Blends® - Quinoa, Kale and Hemp, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149
Real food ingredients Real Food Blends® - Beef, Potatoes, and spinach, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149
Food ingredients Real Food Blends®- Eggs, Apples, and Oats, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149 Gluten Free
Food Ingredients Real Food Blends® - Turkey, Sweet Potatoes, and Peaches, Real Food Blends® Free from soy, corn, dairy, peanuts, and artificial color/flavor B4149
Organic Pea Protein Nourish Peptide, Functional Formularies® Organic, vegan, no dairy, no nuts, no soy, no corn B4149 Free of tree nuts, gluten, dairy, soy, corn and BPAs.
Organic Pea Protein Nourish Peptide - Berry Medley, Functional Formularies® Organic, vegan, no dairy, no nuts, no soy, no corn, 8grams prebiotic vegetable fiber  B4149 Free of gluten, dairy, soy, corn and BPAs.
Organic Pea Protein; Food Ingredients Compleat® Pediatric Peptide 1.5, Nestlé Plant-based, non-GMO, MCT, soluble, insoluble fiber, no dairy, soy, nut corn B4161 Non-GMO, Vegan, Dairy-free, Lactose-free, Gluten free, Plant-Based, Kosher
Organic Pea Protein; Food Ingredients Compleat® Pediatric Peptide 1.0, Nestlé Plant-based, non-GMO, MCT, soluble, insoluble fiber, no dairy, soy, nut corn B4161 Non-GMO, Vegan, Dairy-free, Lactose-free, Gluten free, Plant-Based, Kosher

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