CMS Formulary

Displaying 12741-12750 of 1611142 results.
ID: 12741
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12742
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 855642
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 28
ID: 12743
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 312504
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12744
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 313291
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12745
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245919
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12746
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242786
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12747
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 200329
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12748
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 864681
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12749
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 307731
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12750
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 864675
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0