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

Hydrolyzed; Concentrated Volume | Hydrolyzed; Blenderized | Elemental | Blenderized

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Polymeric; Standard Volume

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Food Ingredients	Compleat®, Nestlé	Standard		B4149	Gluten-Free, no soy, suitable for lactose intolerance	No
Soy Protein	Diabetisource AC®, Nestlé	Low carbohydrate with fiber from fruits and vegetables	Contains soy, no milk protein	B4154	Kosher, Gluten-Free, Lactose free	Yes
Milk and Soy Protein	Fibersource HN®, Nestlé	High protein with fiber	Contains soy	B4150	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Glucerna 1.0 Cal®, Abbott	Low carbohydrate with fiber	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Glucerna 1.2 Cal®, Abbott	Low carbohydrate	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Impact®, Nestlé	Modulating Inflammation/High Protein without fiber	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	Yes
Milk and Soy Protein	Isosource HN®, Nestlé	High protein without fiber	Contains soy	B4150	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Jevity 1.0 Cal®, Abbott	Standard with fiber	Contains soy	B4150	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Jevity 1.2 Cal®, Abbott	Standard with fiber	Contains soy	B4150	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Nutren 1.0®, Nestlé	Standard without fiber	Contains soy	B4150	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Nutren 1.0 Fiber®, Nestlé	Standard with fiber	Contains soy	B4150	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Osmolite 1.0 Cal®, Abbott	Standard without fiber	Contains soy	B4150	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Osmolite 1.2 Cal®, Abbott	Standard without fiber	Contains soy	B4150	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Promote®, Abbott	High protein without fiber	Contains soy	B4150	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Promote with Fiber®, Abbott	High protein with fiber	Contains soy	B4150	Kosher, Gluten-Free, suitable for lactose intolerance	No
Pea protein	Kate Farms Standard 1.0 (chocolate or vanilla), Kate Farms	Standard- plant based		B4150	Lactose-free, Vegan, plant-based, gluten-free, no soy, no corn, no peanuts, no tree nuts, Organic, Non-GMO, Kosher	Yes

Polymeric; Concentrated Volume

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Milk and Soy Protein	Glucerna® 1.5 Cal, Abbott	Low carbohydrate/ Concentrated	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Isosource® 1.5 Cal, Nestlé	With fiber	Contains soy	B4152	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Jevity® 1.5 Cal, Abbott	Concentrated with fiber	Contains soy	B4152	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Nepro® with CARBSTEADY®, Abbott	High protein with fiber/ Low phosphorous, potassium and sodium	Contains soy	B4154	Kosher, Halal(certain flavors), Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Novasource® Renal, Nestlé	High Protein without fiber/ Low phosphorous, potassium, sodium and magnesium	Contains soy	B4154	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Nutren® 1.5, Nestlé	Without fiber	Contains soy	B4152	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Nutren® 2.0, Nestlé	Without fiber	Contains soy	B4152	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk and Soy Protein	Osmolite® 1.5 Cal, Abbott	Concentrated without fiber	Contains soy	B4152	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Pulmocare®, Abbott	Low carbohydrate/ Increased fat without fiber	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Pea protein	Kate Farms Standard 1.4, Kate Farms	Concentrated plant based		B4152	Lactose-free, Vegan, plant-based, gluten-free, no soy, no corn, no peanuts, no tree nuts, Organic, Non-GMO, Kosher	Yes
Milk Protein	Suplena® with CARBSTEADY®, Abbott	Low protein with fiber/ Low phosphorous, potassium and sodium	Contains soy	B4154	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	TwoCal® HN, Abbott		Contains soy	B4152	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No

Hydrolyzed; Standard Volume

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Organic Pea protein	Peptide 1.0, Kate Farms	Hydrolyzed pean protein, contains fiber		B4153	Lactose-free, Vegan, plant-based, gluten-free, no soy, no corn, no peanuts, no tree nuts, Organic, Non-GMO, Kosher
Whey Protein	Peptamen®, Nestlé	High percentage small peptides 70% of fat from MCT, no added fiber	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	No
Whey Protein	Peptamen AF®, Nestlé	Modulating Inflammation/ High Protein with fiber	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	Yes
Whey Protein	Peptamen® Intense VHP, Nestlé	Modulating Inflammation/ Very High Protein with fiber	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	Yes
Whey Protein	Peptamen® with Prebio1TM, Nestlé	High Protein/70% of fat from MCT and with fiber	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Perative®, Abbott	High Protein/ Contains Arginine	Contains soy	B4153	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	Yes
Milk Protein	Vital® 1.0 Cal, Abbott			B4153	Gluten-Free, suitable for lactose intolerance	Yes
Milk Protein	Vital® AF 1.2 Cal, Abbott	Modulating Inflammation/ Increased Protein		B4153	Gluten-Free, suitable for lactose intolerance	Yes
Milk Protein	Vital® HP, Abbott	Modulating Inflammation/ High Protein without fiber		B4153	Gluten-Free, suitable for lactose intolerance	Yes

Hydrolyzed; Concentrated Volume

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Milk Protein	Impact® Peptide 1.5, Nestlé	Modulating Inflammation/ High Protein	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	Yes
Organic Pea Protein	Peptide 1.5, Kate Farms	Hydrolyzed pea protein, contains fiber		B5153	Lactose-free, Vegan, plant-based, gluten-free, no soy, no corn, no peanuts, no tree nuts, Organic, Non-GMO, Kosher
Whey Protein	Peptamen® 1.5, Nestlé	70% of fat from MCT	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	No
Pea protein	Compleat® Peptide 1.5, Nestlé	hydrolyzed pea protein and MCT oil, contains fiber		B4153	Gluten-Free, no soy, suitable for lactose intolerance, Non-GMO	No
Whey Protein	Peptamen® 1.5 with PrebioTM, Nestlé	70% of fat from MCT and with fiber	Contains soy	B4153	Gluten-Free, suitable for lactose intolerance	No
Pea protein	Peptide 1.5® (plain), Kate Farms	Plant based		B4153	Lactose-free, Vegan, Plant-based, gluten-free, no corn, no nuts, no soy, Organic, Non-GMO, Kosher	No
Milk Protein	Pivot® 1.5, Abbott	Modulating inflammation/ High Protein	Contains soy	B4153	Halal, Gluten-Free, suitable for lactose intolerance	Yes
Milk Protein	Renalcal®, Nestlé	Very low protein withour fiber/ Low phosphorous, potassium and magnesium		B4154	Kosher, Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Vital® 1.5 Cal, Abbott			B4153	Gluten-Free, suitable for lactose intolerance	No
Milk Protein	Vital® Peptide 1.5 Cal, Abbott			B4161	Kosher, Halal, Gluten-Free, suitable for lactose intolerance	No

Hydrolyzed; Blenderized

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Organic Hydrolyzed Pea Protein	Liquid Hope Peptide, Functional Formularies	Whole food, hydrolyzed pea protein with MCT oil, contains fiber		B4153	Organic, Gluten-free, dairy free, no soy, no corn, Non-GMO, plant-based, suitable for lactose intolerance
Organic Hydrolyzed Pea Protein	Liquid Hope® Peptide High Protein, Functional Formularies	Contains fiber, contains MCT, plant-based		B4153	Gluten-Free, Dairy-Free, Organic, Non-GMO, no corn, no soy	No

Elemental 

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
100% Free AA	Tolerex®, Nestlé	Low fat/low protein, fiber free, powder		B4153	Kosher, Gluten-Free, Lactose-Free	No
100% Free AA	Vivonex® Plus, Nestlé	Low fat/Fiber Free, contains BCAA's, powder	Contains soy	B4153	Kosher, Gluten-Free, Lactose-Free	No
100% Free AA	Vivonex® RTF, Nestlé	Low fat/fiber free		B4153	Kosher, Gluten-Free, Lactose-Free	No
100% Free AA	Vivonex® T.E.N., Nestlé	Low Fat/fiber free, powder		B4153	Kosher, Gluten-Free, Lactose-Free	No

Blenderized

Composition	Formula Brand Name, Manufacturer	Features	Specifics	HCPCS Code	Additional Details	Contains Immune Nutrients
Blenderized-whole foods	Compleat Organic Blends® Chicken Garden Blend or Plant Based, Nestlé	Standard		B4149 (pending)	Gluten-Free, Lactose-Free, Organic, Non-GMO, no dairy, no soy, no corn	No
Blenderized -whole foods	Compleat Organic Blends® Plant Based, Nestlé	Standard		B4149 (pending)	Gluten-Free, Lactose-Free, Organic, Non-GMO, no dairy, no soy, no corn, plant-based	No
Blenderized - whole foods	Liquid Hope®, Functional Formularies			B4149	Organic, Gluten-free, dairy free, no soy, no corn, Non-GMO, plant-based, suitable for lactose intolerance	No
Blenderized - whole foods	Real Food Blends® -Orange Chicken, Carrots, and Brown, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts	No
Blenderized - whole foods	Real Food Blends® - Salmon, Oats, and Squash, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts.  Oats are gluten-free	No
Blenderized - whole foods	Real Food Blends® - Quinoa, Kale and Hemp, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts	No
Blenderized - whole foods	Real Food Blends® - Beef, Potatoes, and Spinach, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts	No
Blenderized - whole foods	Real Food Blends®- Eggs, Apples, and Oats, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts.  Oats are gluten-free	No
Blenderized - whole foods	Real Food Blends® - Turkey, Sweet Potatoes, and Peaches, RiceReal Food Blends®			B4149	Free from soy, corn, dairy, peanuts.  Oats are gluten-free	No
Blenderized-dehydrated foods	Kale, Quinoa & Berries, Whole Story Meals	Powdered form; protein from sunflower seeds, flax seeds,  and rice protein.		B4149	Vegan, Gluten free, Soy Free, Dairy Free, Egg Free, Corn Free, Lactose Free.	No
Blenderized-dehydrated foods	Chicken, Peas & Carrots, Whole Story Meals	powdered form		B4149	Gluten free, Soy Free, Dairy Free, Egg Free, Corn Free, Lactose Free.	No
Blenderized - dehydrated foods	Restore - Renal Support, Whole Story Meals	Low in protein, potassium, phosphorus, and sodium.  Plant-based with protein from millet, sunflower seeds, and flaxseeds.  Contains fiber.		B4149	Gluten-Free, Soy-Free, Dairy-Free, Egg-Free, Corn-Free, Lactose-Free.	No