CMS Formulary

Displaying 15721-15730 of 1611142 results.
ID: 15721
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898350
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15722
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898353
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15723
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898356
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15724
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898359
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15725
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898342
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15726
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 898346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15727
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15728
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 15729
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15730
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0