CMS Formulary

Displaying 25171-25180 of 1611142 results.
ID: 25171
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1544475
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 25172
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1591949
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 25173
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 2204104
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 25174
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 2204102
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 25175
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1721619
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25176
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747697
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25177
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741739
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25178
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799218
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 25179
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 2288816
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 25180
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1858267
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30