CMS Formulary

Displaying 28721-28730 of 1611142 results.
ID: 28721
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 636042
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28722
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 636045
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28723
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 251872
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 28724
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 314200
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 28725
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 349483
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28726
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 349199
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28727
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 349200
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28728
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 200224
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28729
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 898350
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 28730
Formulary ID: 00021008
Formulary Version: 14
Contract Year: 2021
RXCUI: 898353
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0