CMS Formulary

Displaying 12871-12880 of 1611142 results.
ID: 12871
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 12872
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 12873
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12874
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 12875
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 12876
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944382
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 12877
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944376
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 12878
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 12879
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1866047
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12880
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099026
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0