CMS Formulary

Displaying 30971-30980 of 1611142 results.
ID: 30971
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 763106
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30972
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658241
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30973
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1939299
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 30974
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1939348
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 30975
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 577324
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30976
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 727316
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 30977
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1870207
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 30978
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1374574
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 30979
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2003255
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 30980
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 2198370
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30