CMS Formulary

Displaying 28521-28530 of 1611142 results.
ID: 28521
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 825334
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28522
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 212118
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28523
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 542370
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28524
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28525
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921228
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 28526
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988772
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28527
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988786
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28528
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723763
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 28529
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723767
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 28530
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723772
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28