CMS Formulary

Displaying 22701-22710 of 1611142 results.
ID: 22701
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 483440
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 22702
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 483444
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 22703
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178403
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 22704
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178405
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 22705
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2382990
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 22706
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178407
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 32
Qty Limit Days: 28
ID: 22707
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178409
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 28
ID: 22708
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2382991
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 22709
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2382993
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 22710
Formulary ID: 00021006
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272630
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0