CMS Formulary

Displaying 13171-13180 of 1611142 results.
ID: 13171
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13172
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 700
Qty Limit Days: 30
ID: 13173
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 13174
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 13175
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 997296
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 13176
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 310792
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13177
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 310793
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13178
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 197624
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13179
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1437968
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13180
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1437969
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0