CMS Formulary

Displaying 13071-13080 of 1611142 results.
ID: 13071
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1235591
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13072
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 668606
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13073
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861821
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13074
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861771
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13075
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1729311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 13076
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13077
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1734642
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 13078
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988671
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 13079
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988675
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 13080
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0