CMS Formulary

Displaying 15191-15200 of 1611142 results.
ID: 15191
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658325
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 15192
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658329
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15193
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658333
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15194
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658337
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15195
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658341
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15196
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658345
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15197
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602604
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 15198
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602607
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 15199
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2274816
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 15200
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2274814
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28