CMS Formulary

Displaying 30471-30480 of 1611142 results.
ID: 30471
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 866103
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30472
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 672567
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30473
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 672569
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30474
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 672571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30475
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 993541
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30476
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 993557
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30477
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 996615
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30478
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 996594
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30479
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 996603
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30480
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 996609
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30