CMS Formulary

Displaying 14161-14170 of 1611142 results.
ID: 14161
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 617423
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 14162
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 617993
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 14163
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 314227
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 14164
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 14165
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 14166
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 14167
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 14168
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 14169
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 241946
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 14170
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0