CMS Formulary

Displaying 25371-25380 of 1611142 results.
ID: 25371
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 198012
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25372
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797113
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 25373
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399904
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 25374
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098141
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25375
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098134
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25376
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 577033
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 25377
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 995624
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25378
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 2266506
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 25379
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 857336
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25380
Formulary ID: 00021007
Formulary Version: 14
Contract Year: 2021
RXCUI: 857321
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0