CMS Formulary

Displaying 15581-15590 of 1611142 results.
ID: 15581
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198252
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15582
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649593
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 15583
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1546189
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 15584
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2261794
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 15585
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040058
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15586
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15587
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 794641
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15588
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15589
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15590
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30