CMS Formulary

Displaying 22921-22930 of 1611142 results.
ID: 22921
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 22922
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 860901
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 200
Qty Limit Days: 30
ID: 22923
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 351265
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 22924
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 351266
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 22925
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 22926
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 22927
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 22928
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 700
Qty Limit Days: 30
ID: 22929
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 22930
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30