1 Packet 100 gm 30 packets

10 gm 1 box
(Normal daily (1 month supply)
dose)
TOTAL FAT 0.01 gm 0.13 gm 0.39 gm
SATURATED FAT 0.01 gm 0.08 gm 0.24 gm
POLYUNSATURATED FAT 0 0.01 gm 0.03 gm
MONOUNSATURATED FAT 0 0.04 gm 0.12 gm
CHOLESTEROL 0.04 mg 0.37 mg 1.11 mg
SODIUM 25 mg 250 mg 750 mg
POTASSIUM 30 mg 300 mg 900 mg
TOTAL CARBOHYDRATE 0.10 gm 1.0 gm 3 gm
DIETARY FIBER 0 0 0
SUGARS 0.15 gm 1.5 gm 4.5 gm
PROTEIN 9 gm 90 gm 270 gm
VITAMIN A < 1 gm < 10 gm <30 gm
VITAMIN C 0 0 0
CALCIUM 60 mg 600 mg 1800 mg
MAGNESIUM 9 mg 90 mg 270 mg
CHLORIDE 0.5 mg 5 mg 15 mg
IRON 0.93 mg 9.3 mg 27.90 mg
THIAMIN 0 0 0
RIBOFLAVIN 0 0 0
NIACIN 0 0 0
PHOSPHORUS 21 mg 210 mg 630 mg
CALORIES 37 366 1098
CALORIES FROM FAT 0.1 1.0 3

Medicare HCPCS CODE B4155

NDC Number 28770-0970-01

UPC Code 6-28770-097001

February, 2001