CMS Formulary

Displaying 28401-28410 of 1611142 results.
ID: 28401
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 763457
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28402
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653792
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28403
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1719766
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28404
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1667666
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28405
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1667670
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28406
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1667674
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28407
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1667678
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28408
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741747
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28409
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809471
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28410
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243346
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0