CMS Formulary

Displaying 17271-17280 of 1611142 results.
ID: 17271
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 17272
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17273
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 17274
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 17275
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 17276
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17277
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17278
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 897612
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17279
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 897618
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17280
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 897624
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0