CMS Formulary

Displaying 13901-13910 of 1611142 results.
ID: 13901
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2052704
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13902
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105817
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 13903
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1300797
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13904
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1300803
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13905
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 967388
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13906
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 307730
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13907
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 106302
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13908
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 884308
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 13909
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 106387
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 13910
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 308714
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30