CMS Formulary

Displaying 17661-17670 of 1611142 results.
ID: 17661
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 905379
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17662
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790533
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17663
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791560
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17664
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791569
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17665
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791576
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 17666
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1791582
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 17667
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812015
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17668
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 862006
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17669
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 862013
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17670
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 862019
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0