CMS Formulary

Displaying 25201-25210 of 1611142 results.
ID: 25201
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 897596
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25202
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25203
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25204
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 312847
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25205
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 205284
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25206
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25207
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 25208
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 25209
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25210
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 866479
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0