CMS Formulary

Displaying 12221-12230 of 1611142 results.
ID: 12221
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 886666
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12222
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 886671
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12223
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 686400
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12224
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190572
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12225
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 686418
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12226
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12227
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 12228
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 12229
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12230
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0