CMS Formulary

Displaying 12961-12970 of 1611142 results.
ID: 12961
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 848343
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 12962
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665906
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 12963
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665900
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 12964
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 7
Qty Limit Days: 28
ID: 12965
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2262446
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 12966
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123034
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12967
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2274390
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 12968
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 2282320
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 12969
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1591943
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 12970
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799212
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28