CMS Formulary

Displaying 29481-29490 of 1611142 results.
ID: 29481
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 207100
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29482
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 804547
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29483
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307630
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 29484
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307635
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 29485
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243010
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 29486
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243014
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 29487
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601394
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 29488
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601386
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 29489
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601390
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 29490
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1987734
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30