CMS Formulary

Displaying 12401-12410 of 1611142 results.
ID: 12401
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244062
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 12402
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244064
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 11
Qty Limit Days: 28
ID: 12403
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1596778
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12404
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673274
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 12405
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673278
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 12406
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673280
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 12407
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1925264
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 12408
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049343
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 365
ID: 12409
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 312941
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12410
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 312938
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0