CMS Formulary

Displaying 28471-28480 of 1611142 results.
ID: 28471
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 859975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28472
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 849389
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28473
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28474
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28475
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1536490
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28476
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 310878
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28477
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 311982
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28478
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 104884
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28479
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 861430
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28480
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 886662
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0