CMS Formulary

Displaying 19371-19380 of 1611142 results.
ID: 19371
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1872458
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 19372
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049133
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 19373
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049121
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 19374
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 19375
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 19376
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 19377
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 19378
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 19379
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 19380
Formulary ID: 00021005
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944382
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30