CMS Formulary

Displaying 331-340 of 1611142 results.
ID: 331
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 332
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 825429
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 333
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 884619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 334
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 335
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1656356
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 336
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859501
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 337
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1919094
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 338
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2169314
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 339
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2169322
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 340
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2362240
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30