CMS Formulary

Displaying 17451-17460 of 1611142 results.
ID: 17451
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 17452
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17453
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17454
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17455
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 197550
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17456
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102717
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17457
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102713
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17458
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102715
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17459
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2475840
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 560
Qty Limit Days: 28
ID: 17460
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2107621
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30