CMS Formulary

Displaying 3171-3180 of 1611142 results.
ID: 3171
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058520
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 3172
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058525
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 3173
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 208083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3174
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054275
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 28
ID: 3175
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2275613
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3176
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272118
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3177
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272122
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3178
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272126
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3179
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2394947
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3180
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2199304
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0