CMS Formulary

Displaying 21-30 of 1611142 results.
ID: 21
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745114
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 22
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 729234
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 23
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 582971
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 24
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 582976
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 25
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1435117
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 26
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 351859
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 27
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 28
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 29
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 30
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30