CMS Formulary

Displaying 30401-30410 of 1611142 results.
ID: 30401
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 308207
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30402
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1721475
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30403
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 789980
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30404
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 828755
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30405
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 828539
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30406
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 545835
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30407
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 645884
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30408
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 754508
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 30409
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 197411
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30410
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 310600
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0