CMS Formulary

Displaying 28501-28510 of 1611142 results.
ID: 28501
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356563
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28502
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356572
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28503
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356576
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28504
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356580
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28505
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356584
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28506
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356588
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28507
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790126
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 720
Qty Limit Days: 30
ID: 28508
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 824299
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28509
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 824303
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28510
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054157
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0