CMS Formulary

Displaying 21361-21370 of 1611142 results.
ID: 21361
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739766
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21362
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739774
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21363
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173500
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 21364
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739778
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21365
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739782
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21366
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 795085
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21367
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 849599
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 21368
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 21369
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 21370
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30