CMS Formulary

Displaying 13241-13250 of 1611142 results.
ID: 13241
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 13242
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13243
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2469340
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13244
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 13245
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 13246
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 13247
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13248
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 13249
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741049
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13250
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2273115
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0