CMS Formulary

Displaying 30281-30290 of 1611142 results.
ID: 30281
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30282
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30283
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30284
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30285
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30286
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 897612
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30287
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 897618
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30288
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 897624
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30289
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 897630
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30290
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312025
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0