The drinks are shipped from a house in louisana (2707 madonna dr alexandria la)...how do people know they haven't been tampered with or expired??

Not sure where you're getting that address from, but on the chance that you're not confusing Amazon with Ebay, it could be that someone buys them at a significant discount & in-bulk from Nestle and sells from home a retail. Loads of people do, with loads of different types of items. It's the basis of how retail works. As to whether they're expired or tampered with, each case (if you're buying 24) & bottle is printed with an expiration date. The bottles are sealed with a cap that's extremely, extremely obvious unless your hands are numb & you're deaf.

what do you mix it with?

I don’t mix it with anything. It is ready to drink.

Why is the pricing of this item so out of control?

Look at comparable products and this is by far the most reasonably priced. See Kate Farms 2.0 is about $8-$9 per bottle for 500 calories. I have malabsorption due to severe complications from Crohn’s and this product has really helped me. I drink 4-6 per day in between meals and have been able to maintain weight.

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