CMS Formulary

Displaying 1401-1410 of 1611142 results.
ID: 1401
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 905379
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 1402
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790533
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 1403
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791560
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 1404
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791569
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 1405
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791576
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 1406
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791582
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 1407
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812015
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 1408
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 862006
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 1409
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 862013
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 1410
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 862019
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0