CMS Formulary

Displaying 3371-3380 of 1611142 results.
ID: 3371
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2268227
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 3372
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 402092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3373
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861637
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3374
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3375
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3376
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3377
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3378
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 28
ID: 3379
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 3380
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923338
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0