CMS Formulary

Displaying 30931-30940 of 1611142 results.
ID: 30931
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 259306
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30932
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799654
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30933
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 105292
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30934
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2053458
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30935
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 199592
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 30936
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 805464
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 30937
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659927
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30938
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046585
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 30939
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 403878
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 30940
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098143
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0