CMS Formulary

Displaying 17791-17800 of 1611142 results.
ID: 17791
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 858613
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17792
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 858616
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17793
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 858747
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 17794
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 891881
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 17795
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 891888
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 17796
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 891893
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17797
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 891874
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17798
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 892646
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17799
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 848726
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 17800
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 848738
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30