CMS Formulary

Displaying 3281-3290 of 1611142 results.
ID: 3281
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 3282
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3283
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3284
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3285
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1045404
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3286
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364441
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3287
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364447
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3288
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1145932
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3289
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799230
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3290
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1925255
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0