CMS Formulary

Displaying 30821-30830 of 1611142 results.
ID: 30821
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 967012
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30822
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 198332
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30823
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 197702
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30824
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736047
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 30825
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736050
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 30826
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736053
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 30827
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736044
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 30828
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312845
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30829
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312846
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30830
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 283858
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0