CMS Formulary

Displaying 30771-30780 of 1611142 results.
ID: 30771
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 809871
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 30
ID: 30772
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 864661
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30773
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001424
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30774
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1363408
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 30775
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1363410
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 30776
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364581
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 30777
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790175
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30778
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790167
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30779
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790171
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30780
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1928941
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30