CMS Formulary

Displaying 29621-29630 of 1611142 results.
ID: 29621
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 29622
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 29623
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123314
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29624
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121096
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 29625
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121100
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 29626
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2390954
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 29627
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29628
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29629
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 29630
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720881
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0