CMS Formulary

Displaying 31721-31730 of 1611142 results.
ID: 31721
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 403855
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31722
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 859981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 31723
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 859975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 31724
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 849389
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31725
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31726
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31727
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 1536490
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31728
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 310878
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31729
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 311982
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 31730
Formulary ID: 00021009
Formulary Version: 14
Contract Year: 2021
RXCUI: 104884
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0