Nestlé HealthCare Nutrition Product Code Cross Reference
Nestlé HealthCare Nutrition Product Code Cross Reference
Nestlé HealthCare Nutrition Product Code Cross Reference
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<strong>Product</strong> and SKU Description<br />
TUBE FEEDING FORMULAS<br />
Each UPC Case UPC (GTIN)<br />
COMPLEAT ®<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
<strong>Nestlé</strong> <strong>HealthCare</strong> <strong>Nutrition</strong> <strong>Product</strong> <strong>Code</strong> <strong>Cross</strong> <strong>Reference</strong><br />
(Institutional and Retail <strong>Product</strong>s - Excludes Devices and Foods)<br />
Changes Noted in Red<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
043900140100 10043900140107 00212140151 14010000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900141800 10043900141807 00212141814 43900014180 14180100<br />
Closed System Containers with SpikeRight ® port<br />
6 x 1500 mL To be replaced by item below 043900141824 10043900141821 00212182414 43900014182 14182000<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900141824 10043900141838 00212182414 43900014182 4390014183<br />
COMPLEAT ® PEDIATRIC B4149<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
COMPLEAT ® PEDIATRIC REDUCED CALORIE- New <strong>Product</strong><br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
CRUCIAL ® Will be discontinued, Replaced by IMPACT® PEPTIDE 1.5<br />
043900142401 10043900142408 00212142451 43900014240 14240000<br />
043900380742 10043900380749 43900038074 4390038074<br />
Unflavored 24 x 250 mL cans 798716062800 00798716162807 0065912470 9871616280<br />
UltraPak ® with SpikeRight ® port 6 x 1000 mL 798716162838 10798716262849 00212628461 98716016283 9871626284<br />
HCPCS<br />
<strong>Code</strong><br />
B4149<br />
B4149<br />
B4153
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
DIABETISOURCE ® AC<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
Unflavored 24 x 250 mL cans 043900365008 10043900365005 00212365051 36500000<br />
Closed System Containers with SpikeRight ® port<br />
6 x 1000 mL 043900365084 10043900365081 00212365014 43900036508 36508100<br />
Closed System Containers with SpikeRight ® port<br />
6 x 1500 mL To be replaced by item below<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
043900365824 10043900365821 00212365814 43900036582 36582000<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900365824 10043900365838 00212365814 43900036582 4390036583<br />
FIBERSOURCE ® HN B4150<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
Unflavored 24 x 250 mL Tetra Prisma 043900185552 10043900185504 00212185551 18550000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL<br />
Closed System Containers with SpikeRight<br />
043900185880 10043900185887 00212185814 43900018588 18580100<br />
® port<br />
6 x 1500 mL To be replaced by item below<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
043900185828 10043900185825 00212885214 43900018582 18582000<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900185828 10043900185832 00212185214 43900018582 4390018583<br />
GLYTROL ® Name Change<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062756 00798716162753 0065908570 9871616275<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716163767 10798716223901 00212239061 98716016376 9871622390<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 798716163774 00798716323918 00212239161 98716016377 9871632391<br />
IMPACT ®<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900358109 10043900358106 00212358151 35810000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900358185 10043900358182 00212358114 43900035818 35810800<br />
IMPACT<br />
Unflavored 24 x 250 mL 043900358901 10043900358908 00212358951 35890000<br />
® 1.5 Will be discontinued, Replaced by IMPACT® PEPTIDE 1.5<br />
HCPCS<br />
<strong>Code</strong><br />
B4154<br />
B4154<br />
Pending<br />
B4154<br />
Pending<br />
B4154<br />
B4154
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
IMPACT ® with FIBER B4154<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900358703 10043900358700 00212358751 35870000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900230511 10043900230518 00212358814 43900023051 35880100<br />
IMPACT ® GLUTAMINE B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900162102 10043900162109 00212162151 16210000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900162881 10043900162888 00212162814 43900016288 16280100<br />
IMPACT ® PEPTIDE 1.5 B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900973999 10043900974009 43900097399 4390097400<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900973708 10043900973712 43900097370 4390097371<br />
ISOSOURCE ® 1.5 CAL<br />
®<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
043900181509 10043900181506 00212181551 18150000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL<br />
Closed System Containers with SpikeRight<br />
043900181813 10043900181810 00212181814 43900018181 18180100<br />
® port<br />
6 x 1500 mL To be replaced by item below<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
043900181820 10043900181827 00212182014 43900018182 18182000<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900181820 10043900281824 00212182014 43900018182 4390028182<br />
ISOSOURCE ® HN<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900184579 10043900184507 00212184551 18450000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900184807 10043900184804 00212184814 43900018480 18480100<br />
Closed System Containers with SpikeRight ® port<br />
6 x 1500 mL To be replaced by item below<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
043900184661 10043900184668 00212846214 43900018466 18462800<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900184661 10043900284665 00212846214 43900018466 4390028466<br />
HCPCS<br />
<strong>Code</strong><br />
B4152<br />
Pending<br />
B4150<br />
Pending
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
NOVASOURCE ® RENAL B4154<br />
Vanilla 27 x 8 fl oz Tetra Brik ®<br />
Closed System Containers with SpikeRight<br />
043900351117 10043900351107 00212351162 35110000<br />
® port<br />
6 x 1000 mL 043900351803 10043900351800 00212351814 43900035180 35180100<br />
NUTREN ® 1.0 B4150<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062107 00798716162104 0065902470 98716006210 9871616210<br />
NUTREN ® 1.0 FIBER B4150<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716060561 00798716160568 0065902570 9871616056<br />
NUTREN ® 1.5 B4152<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
Vanilla 24 x 250 mL Tetra Prisma 798716062206 00798716162203 0065903270 9871616220<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716163545 10798716263549 00212120414 98716016354 9871626354<br />
NUTREN ® 2.0 B4152<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062305 00798716162302 0065904070 9871616230<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716331470 00798716441469 00212414661 98716033147 9871644146<br />
B4154<br />
Vanilla 24 x 250 mL cans 798716062756 00798716162753 0065908570 9871616275<br />
UltraPak ® with SpikeRight ® port 6 x 1000 mL 798716163767 10798716223901 00212239061 98716016376 9871622390<br />
UltraPak ® with SpikeRight ® port 4 x 1500 mL 798716163774 00798716323918 00212239161 98716016377 9871632391<br />
NUTREN JUNIOR ®<br />
B4160<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716060622 00798716160629 0065904370 9871616062<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716673709 00798716773805 00212738061 98716067370 9871677380<br />
NUTREN JUNIOR ® FIBER B4160<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
NUTREN<br />
798716060639 00798716160636 0065904570 9871616063<br />
® GLYTROL ® Name Changed to GLYTROL®<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716673907 00798716774000 00212741061 98716067390 9871677400<br />
HCPCS<br />
<strong>Code</strong>
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
NUTREN ® PULMONARY B4154<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716064804 00798716164801 0065914170 98716006480 9871616480<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716163620 10798716223925 00212239261 98716016362 9871622392<br />
NUTREN<br />
Vanilla 24 x 250 mL cans 798716062497 00798716162494 0065902270 9871616249<br />
® REPLETE ® Name Changed to REPLETE ®<br />
UltraPak ® with SpikeRight ® port 6 x 1000 mL 798716163569 10798716263563 00212457914 98716016356 9871626356<br />
Vanilla 24 x 250 mL cans 798716062459 00798716162456 0065902370 9871616245<br />
UltraPak ® with SpikeRight ® NUTREN<br />
port 6 x 1000 mL 798716163583 10798716263587 00212635861 98716016358 9871626358<br />
® REPLETE ® FIBER Name Changed to REPLETE ® FIBER<br />
UltraPak ® with SpikeRight ® port 4 x 1500 mL 798716163590 10798716263594 00212635961 98716016359 9871626359<br />
®<br />
NUTRIHEP ®<br />
B4154<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716064798 00798716164795 0065907870 9871616479<br />
PEPTAMEN ®<br />
B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716062695 00798716162692 0065901470 98716006269 9871616269<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062602 00798716162609 0065906770 98716006260 9871616260<br />
PEPTAMEN ® 1.5 B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716081924 00798716181921 0065908870 98716008192 9871618192<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716081900 00798716181907 0065908770 98716008190 9871618190<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716181945 10798716281949 00212819461 98716018194 9871628194<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
PEPTAMEN<br />
043900349589 10043900349586 43900034958 4390034958<br />
® 1.5 with PREBIO 1TM New <strong>Product</strong><br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL<br />
PEPTAMEN AF<br />
043900349572 10043900349579 43900034957 4390034957<br />
®<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716663601 00798716663700 0065909271 9871666370<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716663809 00798716763905 00212639061 98716066380 9871676390<br />
HCPCS<br />
<strong>Code</strong><br />
B4150<br />
B4150<br />
B4153<br />
B4153
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
PEPTAMEN ® BARIATRIC B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900972343 10043900972357 43900097234 4390097235<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 043900972664 10043900972678 43900097266 4390097267<br />
PEPTAMEN ® with PREBIO 1TM<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716181853 10798716181850 0065907670 98716018185 9871618185<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716128049 10798716228043 00212280461 98716012804 9871622804<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 798716128056 10798716228050 00212280561 98716012805 9871622805<br />
PEPTAMEN JUNIOR ®<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
Chocolate 24 x 250 mL Tetra Prisma ®<br />
Strawberry 24 x 250 mL Tetra Prisma ®<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716062527 00798716162524 0065907070 9871616252<br />
798716601108 00798716601207 0065907071 9871660120<br />
798716601405 00798716601306 0065907072 9871660130<br />
798716062534 00798716162531 0065906970 9871616253<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716673501 00798716773607 00212740061 98716067350 9871677360<br />
PEPTAMEN JUNIOR ® 1.5 B4161<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716073639 00798716173636 00212847315 98716007363 9871617363<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716085434 00798716185431 00212841515 98716008543 9871618543<br />
PEPTAMEN JUNIOR ® FIBER B4161<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716602006 00798716602105 0065906871 9871660210<br />
PEPTAMEN JUNIOR ® with PREBIO 1 B4161<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716162616 10798716162613 0065906870 9871616261<br />
RENALCAL ®<br />
B4154<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
798716060646 00798716160643 0065901370 9871616064<br />
HCPCS<br />
<strong>Code</strong><br />
B4153<br />
B4161
NDC First Data Bank<br />
Formatted NDC Formatted <strong>Product</strong> HCPCS<br />
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN) Number Number* <strong>Code</strong> <strong>Code</strong><br />
REPLETE ® Name Change B4150<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062497 00798716162494 0065902270 98716006249 9871616249<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716163569 10798716263563 00212457914 98716016356 9871626356<br />
REPLETE ® FIBER Name Change B4150<br />
Vanilla 24 x 250 mL Tetra Prisma ®<br />
798716062459 00798716162456 0065902370 98716006245 9871616245<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL 798716163583 10798716263587 00212635861 98716016358 9871626358<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 798716163590 10798716263594 00212635961 98716016359 9871626359<br />
TOLEREX ®<br />
60 x 2.82 oz (80 g) pkts 043900458069 10043900458059 00212458072 04580500<br />
VIVONEX ® VIVONEX PEDIATRIC B4161<br />
Unflavored 36 x 48.5 g (1.7 oz) pkts 043900713199 10043900713103 00212713176 07131000<br />
VIVONEX ® PLUS B4153<br />
Unflavored 36 x 2.8 oz (79 g) pkts 043900712994 10043900712984 00212729818 07129800<br />
VIVONEX ® RTF B4153<br />
Unflavored 24 x 250 mL Tetra Prisma ®<br />
043900362502 10043900362509 00212362551 43900036250 36250000<br />
SpikeRight ® PLUS UltraPak ® 6 x 1000 mL<br />
Closed System Containers with SpikeRight<br />
043900362809 10043900362806 00212362814 43900036280 36280100<br />
® port<br />
6 x 1500 mL To be replaced by item below<br />
Pack factor change, replaces 6 x 1500 mL<br />
product noted above.<br />
043900362823 10043900362820 00212628214 43900036282 36282000<br />
SpikeRight ® PLUS UltraPak ® 4 x 1500 mL 043900362823 10043900362837 00212628214 43900036282 4390036283<br />
VIVONEX ® T.E.N. B4153<br />
Unflavored 60 x 80.4 g (2.84 oz) pkts<br />
ORAL SUPPLEMENTS<br />
043900712741 10043900712748 00212727873 07127400<br />
ARGINAID ® Name Change B4155<br />
Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 00212598375 35983000<br />
Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 00212598475 35984000<br />
B4153
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
BENECALORIE ® Name Change B4155<br />
24- 1.5 fl oz cups/case 043900282503 10043900282500 00212282580 28250000<br />
BENEPROTEIN ® Name Change B4155<br />
Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 28430000<br />
Powder 6 x 8 fl oz 043900284101 10043900284108 00212284107 28410000<br />
BOOST B4150<br />
Vanilla 24 x 237 mL bottle 043900674391 00043900674308 00212674313 43900067439 06743900<br />
® (INSTITUTIONAL) Former<br />
Chocolate 24 x 237 mL bottle 043900675398 00043900675305 00212675313 43900067539 06753900<br />
Strawberry 24 x 237 mL bottle 043900676388 00043900676302 00212067613 43900067638 06763800<br />
BOOST B4150<br />
® (INSTITUTIONAL) New Case Count, UPC and <strong>Product</strong> <strong>Code</strong>s B4150<br />
Vanilla 27 x 237 ml Tetra Brik ®<br />
043900674391 10043900674381 00212674313 43900067439 4390067438<br />
Chocolate 27 x 237 ml Tetra Brik ®<br />
043900675398 10043900675388 00212675313 43900067539 4390067538<br />
Strawberry 27 x 237 ml Tetra Brik ®<br />
043900676388 10043900676392 00212067613 43900067638 4390067639<br />
BOOST ® BOOST (INSTITUTIONAL) New Case Count, UPC and <strong>Product</strong> <strong>Code</strong>s<br />
(RETAIL) B4150<br />
Vanilla 24 (4x6 Pk) x 237 mL bottle 041679674000 00041679674369 41679067466 06743600<br />
Chocolate 24 (4x6 Pk) x 237 mL bottle 041679675007 00041679675366 41679067566 06753600<br />
Strawberry 24 (4x6 Pk) x 237 mL bottle 041679676004 00041679676363 41679067666 06763600<br />
BOOST GLUCOSE CONTROL<br />
Vanilla 27 x 8 fl oz 043900360119 10043900360109 00212360162 36010000<br />
Strawberry 27 x 8 fl oz 043900360317 10043900360307 00212360362 36030000<br />
® (INSTITUTIONAL)<br />
Chocolate 27 x 8 fl oz 043900360218 10043900360208 00212360262 36020000<br />
BOOST GLUCOSE CONTROL ® (RETAIL) B4154<br />
Vanilla 24 (4x6 Pk) x 237 mL bottle 041679157824 00041679157800 41679015781 15780000<br />
Chocolate 24 (4x6 Pk) x 237 mL bottle 041679157923 00041679157909 41679015791<br />
Pending FDB<br />
15790000<br />
Strawberry 24 (4x6 Pk) x 237 mL bottle 041679158111 00041679158104 41679015812 review<br />
15810000<br />
HCPCS<br />
<strong>Code</strong><br />
B4154
NDC First Data Bank<br />
Formatted NDC Formatted <strong>Product</strong><br />
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN) Number Number* <strong>Code</strong><br />
BOOST<br />
Vanilla 24 x 237 mL bottle 043900941394 00043900941301 00212941313 43900094139 09413900<br />
® HIGH PROTEIN (INSTITUTIONAL) Former<br />
B4150<br />
Vanilla 27 x 237 ml Tetra Brik ®<br />
043900941394 10043900941391 00212941313 43900094139 4390094139<br />
BOOST ® BOOST<br />
HIGH PROTEIN (RETAIL) B4150<br />
Vanilla 24 (4x6 Pk) x 237 mL bottle 041679941003 00041679941362 41679094166 09413600<br />
Chocolate 24 (4x6 Pk) x 237 mL bottle 041679940006 00041679940365 41679094066 09403600<br />
® HIGH PROTEIN (INSTITUTIONAL) New Case Count, UPC and <strong>Product</strong> <strong>Code</strong>s<br />
Strawberry 24 (4x6 Pk) x 237 mL bottle 041679944004 00041679944363 41679094466 09443600<br />
Vanilla 27 x 237 mL Tetra Brik ®<br />
BOOST ® KID ESSENTIALS (INSTITUTIONAL)<br />
Vanilla 27 x 237 mL Tetra Brik ®<br />
043900335117 10043900335114 00212335113 43900033511 33510000<br />
Chocolate 27 x 237 ml Tetra Brik ®<br />
043900335209 10043900335220 00212335213 43900033520 33520000<br />
Strawberry 27 x 237 mL Tetra Brik ®<br />
043900335308 10043900335336 00212335313 43900033530 33530000<br />
BOOST ® KID ESSENTIALS (RETAIL) B4160<br />
Vanilla 16 (4x4 Pk) x 244 mL 041679332511 041679339688 00212332513 41679033251 12126200<br />
Chocolate 16 (4x4 Pk) x 244 mL 041679332610 041679339787 00212332613 41679033261 12126189<br />
Vanilla 27 x 237 ml Tetra Brik ®<br />
043900335407 10043900335442 00212335413 43900033540 33540000<br />
Strawberry 27 x 237 ml Tetra Brik ®<br />
043900335902 10043900335992 00212335913 43900033590 33590000<br />
Chocolate 27 x 237 ml Tetra Brik ®<br />
BOOST<br />
043900335889 10043900335886 00212335813 43900033588 33580000<br />
® KID ESSENTIALS 1.5 (INSTITUTIONAL)<br />
With Fiber, Vanilla 27 x 237 mL Tetra Brik ®<br />
043900335001 10043900335008 00212335013 43900033500 33500000<br />
BOOST PLUS<br />
Vanilla 24 x 237 mL bottle 043900931395 00043900931302 00212931313 43900093139 09313900<br />
Strawberry 24 x 237 mL bottle 043900933382 00043900933306 00212933313 43900093338 09333800<br />
Chocolate 24 x 237 mL bottle 043900932392 00043900932309 00212932313 43900093239 09323900<br />
® (INSTITUTIONAL) Former<br />
HCPCS<br />
<strong>Code</strong><br />
B4150<br />
B4160<br />
B4160<br />
B4152
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
B4152<br />
Vanilla 27 x 237 ml Tetra Brik ®<br />
043900931395 10043900931385 00212931313 43900093139 4390093138<br />
Chocolate 27 x 237 ml Tetra Brik ®<br />
043900932392 10043900932382 00212932313 43900093239 4390093238<br />
Strawberry 27 x 237 ml Tetra Brik ®<br />
043900933382 10043900933310 00212933313 43900093338 4390093331<br />
BOOST PLUS ® BOOST PLUS<br />
(RETAIL) B4152<br />
Vanilla 24 (4x6 Pk) x 237 mL bottle 041679931004 00041679931363 41679093166 09313600<br />
Chocolate 24 (4x6 Pk) x 237 mL bottle 041679932001 00041679932360 41679093266 09323600<br />
® (INSTITUTIONAL) New Case Count, UPC and <strong>Product</strong> <strong>Code</strong>s<br />
Strawberry 24 (4x6 Pk) x 237 mL bottle 041679933008 00041679933367 41679093366 09333600<br />
BOOST ® VHC Very High Calorie (INSTITUTIONAL) Replaces CARNATION® INSTANT BREAKFAST® LACTOSE FREE VHC<br />
Vanilla 27 x 237 ml Tetra Brik ®<br />
043900182155 10043900182169 43900018215 4390018216<br />
CARNATION<br />
Vanilla Swirl 24 x 250 mL 798716038898 00798716338882 0065905070 9871633888<br />
Chocolate Splash 24 x 250 mL 798716038911 00798716338905 0065905071 9871633890<br />
® INSTANT BREAKFAST ® LACTOSE FREE Discontinued<br />
CARNATION<br />
Vanilla Swirl 24 x 250 mL 798716038959 00798716389402 0065905073 9871638940<br />
Chocolate Splash 24 x 250 mL 798716038973 00798716338967 0065905074 9871633896<br />
® INSTANT BREAKFAST ® LACTOSE FREE PLUS Discontinued<br />
B4152<br />
Vanilla 24 x 250 mL 798716039017 00798716339001 0065905076 9871633900<br />
GLUTASOLVE ® Name Change B4155<br />
56 x 22.5 g (0.79 oz) pkts 043900283005 10043900283309 00212283378 28330000<br />
IMPACT ADVANCED RECOVERY ®<br />
B4154<br />
Vanilla 15 X 8 fl oz 043900195506 10043900195510 00212195562 19571000<br />
Chocolate 15 X 8 fl oz 043900195605 10043900195619 00212195662 19581000<br />
MCT OIL ® CARNATION<br />
(Medium Chain Triglycerides) B4155<br />
6 x 1 Qt Amber bottle 041679365038 00041679365137 41679036513 03651300<br />
® INSTANT BREAKFAST ® LACTOSE FREE VHC Replaced by BOOST® VHC<br />
HCPCS<br />
<strong>Code</strong><br />
B4152<br />
B4150<br />
B4152
MICROLIPID ®<br />
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
48 x 3 fl oz bottle 041679087435 00041679087022 41679008702 00870200<br />
NUTRAMENT ® (RETAIL) N/A<br />
Vanilla 24 x 12 fl oz cans 041679633120 00041679633014 41679063301 06330100<br />
Chocolate 24 x 12 fl oz cans 041679632123 00041679632017 41679063201 06320100<br />
Strawberry 24 x 12 fl oz cans 041679634127 00041679634011 41679063401 06340100<br />
Coconut 24 x 12 fl oz cans 041679636121 00041679636015 41679063601 06360100<br />
Banana 24 x 12 fl oz cans 041679635124 00041679635018 41679063501 06350100<br />
Egg Nog 24 x 12 fl oz cans 041679637128 00041679637012 41679063701 06370100<br />
Dulce De Leche 24 x 12 fl oz cans 041679603413 00041679603017 41679060301 16030100<br />
NUTRISOURCE ® FIBER Name Change g<br />
B4104<br />
HCPCS<br />
<strong>Code</strong><br />
B4155<br />
Powder 75 x 0.14 oz pkts 043900976471 10043900976485 43900097647 4390097648<br />
Powder 4 x 7.2 oz Canister 043900975504 10043900975518 43900097550 4390097551<br />
OPTIFAST HP® Pending<br />
Vanilla 60-1.75 oz packets 043900174105 10043900174102 00212174125 17410000<br />
Chocolate 60-1.8 oz packets<br />
OPTISOURCE® HIGH PROTEIN DRINK<br />
043900174204 10043900174201 00212174225 17420000<br />
Caramel 27-8 fl oz Tetra Brik® 043900174716 00043900174716 00212174717 17471000 B4150<br />
Strawberry 27-8 fl oz Tetra Brik® 043900174815 00043900174815 00212174817 17481000<br />
RESOURCE ® 2.0 B4152<br />
Vanilla Creme 27 x 8 fl oz 043900180106 10043900180103 00212180162 18010000<br />
Vanilla Creme 12 x 32 fl oz 043900276007 10043900276004 00212276065 27600000<br />
RESOURCE ARGINAID B4155<br />
Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 00212598375 35983000<br />
Lemon 56 x 0.32 oz (9 g) pkts 043900359823 10043900359851 00212598575 35985000<br />
Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 00212598475 35984000<br />
® Name Changed to ARGINAID®
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
RESOURCE ARGINAID EXTRA ®<br />
Orange Burst 27 x 8 fl oz 043900196602 10043900196609 00212196662 19660000<br />
Wildberry 27 x 8 fl oz 043900196701 10043900196708 00212196762 19670000<br />
RESOURCE® BENECALORIE<br />
24- 1.5 fl oz cups 043900282503 10043900282500 00212282580 28250000<br />
Powder 75 x 4 g (0.14 oz) pkts 043900282305 10043900282302 00212282374 28230000<br />
Powder 4 x 7.2 oz (205 g) canister 043900282107 10043900282104 00212282107 28210000<br />
® Name Changed to BENECALORIE ®<br />
RESOURCE ® BENEFIBER ®∆ Name Changed to NUTRISOURCE ® FIBER<br />
RESOURCE® BENEPROTEIN ® Name Changed to BENEPROTEIN ®<br />
Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 28430000<br />
Powder 6 x 8 fl oz 043900284101 10043900284108 00212284107 28410000<br />
RESOURCE ® BREEZE B4154<br />
Orange 27 x 8 fl oz 043900186290 10043900186204 00212186262 18620000<br />
Peach 27 x 8 fl oz 043900186498 10043900186402 00212186462 18640000<br />
Wild Berry 27 x 8 fl oz 043900186665 10043900186600 00212186662 18660000<br />
Variety Case 27 x 8 fl oz<br />
Orange-<br />
043900186290<br />
Peach-<br />
043900186498<br />
Wild Berry-<br />
043900186665<br />
10043900186006 00212186062 18600000<br />
RESOURCE ® DIABETISHIELD ®<br />
Orange Twist 27 x 8 fl oz 043900349107 10043900349104 00212349162 34910000<br />
Mixed Berry 27 x 8 fl oz 043900349305 10043900349302 00212349362 34930000<br />
HCPCS<br />
<strong>Code</strong><br />
B4102<br />
B4155<br />
B4104<br />
B4155<br />
B4154
NDC<br />
Formatted<br />
Number<br />
First Data Bank<br />
NDC Formatted<br />
Number*<br />
<strong>Product</strong><br />
<strong>Code</strong><br />
<strong>Product</strong> and SKU Description Each UPC Case UPC (GTIN)<br />
56 x 22.5 g (0.79 oz) pkts<br />
RESOURCE<br />
043900283005 10043900283309 00212283378 28330000<br />
® THICKENUP ®<br />
RESOURCE<br />
Unflavored 75 x 0.22 oz (6.4 g) pkts 043900225418 10043900225408 00212225471 22540000<br />
Unflavored 12 x 8 oz (227 g) cans 043900225104 10043900225101 00212225107 22510000<br />
Unflavored 1 x 25 lb (11.34 kg)bag/box 10043900225309 10043900225309 00212225305 22530000<br />
12 x 125 g (4.4 oz) canister 041679151945 00041679151952 41679015194 4617915195<br />
2-pack 4.4 oz (2x6 ct case) canister 041679151945 00041679151976 41679015194 4167915197<br />
® GLUTASOLVE ® Name Changed to GLUTASOLVE ®<br />
RESOURCE ® THICKENUP ® CLEAR (RETAIL) New <strong>Product</strong><br />
Sticks 24 x 12 ct case 041679151921 00041679151938 41679015191 4167915193<br />
RESOURCE ® THICKENUP ® CLEAR (INSTITUTIONAL) New <strong>Product</strong><br />
288 x 1.4 g stick packets 043900151915 10043900151936 43900015191 4390015193<br />
12 x 125 g (4.4 oz) canister 043900151946 10043900151950 43900015194 4390015195<br />
5 Kg 1 ct case na 10043900151981 43900015198 4390015198<br />
∆ Benefiber® is the registered trademark of Novartis AG and is used under license.<br />
Updated 4.13.12<br />
HCPCS<br />
<strong>Code</strong><br />
* First Data Bank NDC Format Number - Since <strong>Nestlé</strong> no longer prints NDC Format <strong>Code</strong>s on product labels, FDB uses the product UPC code to create a number that can be found in the<br />
"NDC" field of the FDB publication.<br />
Reimbursement information provided by <strong>Nestlé</strong> <strong>HealthCare</strong> <strong>Nutrition</strong>, Inc., (HCN) is gathered from third party sources and is presented for illustrative purposes only. This information does not<br />
constitute reimbursement or legal advice and does not constitute a recommendation related to medical necessity or the documentation that should be provided in connection with a given<br />
patient or claim. All medical necessity determinations must be made by the responsible clinician. HCN makes no representation or warranty regarding this information or its completeness,<br />
accuracy, timeliness, or applicability to a particular patient. HCN specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information<br />
in this document. Suppliers are responsible for submitting accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and<br />
change frequently. Accordingly, HCN recommends that you consult with your payers, reimbursement specialist and/or legal counsel regarding coding, coverage and reimbursement matters.<br />
Please be advised that certain <strong>Nestlé</strong> <strong>HealthCare</strong> <strong>Nutrition</strong>, Inc., products have been assigned NDC Formatted Numbers. NDC Formatted Numbers are not actual National Drug <strong>Code</strong>s<br />
(NDC). NDC Formatted Numbers are product codes adjusted according to standard industry practice to meet the format requirements of certain suppliers and payers. <strong>Nestlé</strong> <strong>HealthCare</strong><br />
<strong>Nutrition</strong> submits product information including various product codes to the compendia including First Data Bank, RedBook and Medispan but cannot confirm that the NDC Formatted<br />
Numbers submitted have been published by the compendia.<br />
Except as noted all trademarks are owned by Société des Produits <strong>Nestlé</strong> S.A., Vevey, Switzerland or are used with permission. (c) 2012 <strong>Nestlé</strong><br />
B4155<br />
B4100<br />
B4100<br />
B4100