CMS Formulary

Displaying 13501-13510 of 1611142 results.
ID: 13501
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 308865
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 13502
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860154
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13503
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860151
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13504
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860127
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13505
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856448
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13506
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856457
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13507
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856519
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13508
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856578
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13509
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856556
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13510
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856605
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0