CMS Formulary

Displaying 13751-13760 of 1611142 results.
ID: 13751
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198274
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13752
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198275
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13753
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198270
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13754
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 197960
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13755
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198285
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13756
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 856422
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13757
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 199903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13758
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 998671
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 13759
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 998675
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 13760
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 998679
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28