Displaying 10401-10410 of 1611142 results.
		ID:
	10401	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	1001004	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10402	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	351264	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	0	
	
Qty Limit Amt:
	90	
	
Qty Limit Days:
	30	
	
 
		ID:
	10403	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	904605	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10404	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	904571	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10405	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	904583	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10406	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	904593	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10407	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	848951	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10408	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	834346	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10409	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	993466	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
		ID:
	10410	
	Formulary ID:
	00021003	
	
Formulary Version:
	14	
	
Contract Year:
	2021	
	
RXCUI:
	993470	
	
NDC:
		
	Tier Level:
	1	
	
Qty Limit?:
	1	
	
Qty Limit Amt:
	0	
	
Qty Limit Days:
	0	
	
 
 
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