CMS Formulary

Displaying 15171-15180 of 1611142 results.
ID: 15171
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 903841
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15172
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1114470
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15173
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049504
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15174
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049545
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15175
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049565
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15176
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049576
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15177
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049586
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15178
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049595
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15179
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049601
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15180
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1544404
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0