CMS Formulary

Displaying 30841-30850 of 1611142 results.
ID: 30841
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 857169
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30842
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 857183
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30843
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 857187
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30844
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 197732
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30845
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312750
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30846
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312748
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30847
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 312079
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 30848
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 208185
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30849
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 577127
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 30850
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 403908
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0