CMS Formulary

Displaying 341-350 of 1611142 results.
ID: 341
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2169320
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 342
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2362244
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 343
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1365866
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 344
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1656351
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 345
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1873991
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 346
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1873993
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 42
Qty Limit Days: 28
ID: 347
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1873995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 63
Qty Limit Days: 28
ID: 348
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1421456
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 349
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923054
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 49
Qty Limit Days: 28
ID: 350
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801840
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30