CMS Formulary

Displaying 30801-30810 of 1611142 results.
ID: 30801
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 858747
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30802
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 891881
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 30803
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 891888
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 30804
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 891893
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30805
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 891874
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30806
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 892646
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30807
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 848726
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30808
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 848738
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30809
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 848742
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30810
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 848746
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30