CMS Formulary

Displaying 30291-30300 of 1611142 results.
ID: 30291
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 198041
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30292
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 582926
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30293
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597123
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 30294
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597129
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 30295
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 238134
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 30296
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745091
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 30297
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801289
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30298
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 311892
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30299
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 311893
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30300
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 199521
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30