CMS Formulary

Displaying 30321-30330 of 1611142 results.
ID: 30321
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 28
ID: 30322
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 30323
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30324
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30325
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30326
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30327
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430449
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30328
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1592748
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30329
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1592752
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30330
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243033
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30