CMS Formulary

Displaying 13361-13370 of 1611142 results.
ID: 13361
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 13362
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 13363
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123314
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13364
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121096
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 13365
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121100
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 13366
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2390954
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 13367
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13368
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13369
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13370
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720881
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0