CMS Formulary

Displaying 12841-12850 of 1611142 results.
ID: 12841
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 308867
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12842
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1092357
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12843
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665473
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 12844
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1798370
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 12845
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1798375
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 12846
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 200132
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 12847
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 199149
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 12848
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 199150
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 12849
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 311915
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12850
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1725064
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30