CMS Formulary

Displaying 27871-27880 of 1611142 results.
ID: 27871
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 849599
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 27872
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 27873
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27874
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27875
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251918
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27876
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 724142
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27877
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 724156
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27878
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251922
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 27879
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739788
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 27880
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1149617
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30