CMS Formulary

Displaying 21021-21030 of 1611142 results.
ID: 21021
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790175
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 21022
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790167
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 21023
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790171
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21024
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1928941
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 21025
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 197703
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21026
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1300783
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21027
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 831261
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21028
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 829500
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21029
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 861025
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 765
Qty Limit Days: 30
ID: 21030
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 881341
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0