CMS Formulary

Displaying 26291-26300 of 1611142 results.
ID: 26291
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747577
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 26292
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747579
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 26293
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747567
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 26294
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747580
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26295
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921017
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26296
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921010
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26297
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921468
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26298
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 152971
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26299
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 2166143
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 26300
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 2196900
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0