CMS Formulary

Displaying 15791-15800 of 1611142 results.
ID: 15791
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861232
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 15792
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1367436
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 15793
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15794
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15795
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1361615
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15796
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1361226
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15797
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861363
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15798
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861365
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15799
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 861356
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 15800
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1737244
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0