CMS Formulary

Displaying 30391-30400 of 1611142 results.
ID: 30391
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 199119
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30392
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 864110
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30393
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 854302
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30394
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1793916
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 30395
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657160
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 30396
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1654630
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30397
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2000007
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 30398
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 309339
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30399
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 309335
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30400
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 309336
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0