CMS Formulary

Displaying 3491-3500 of 1611142 results.
ID: 3491
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3492
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 3493
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741049
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3494
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2273115
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3495
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 616283
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3496
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284106
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 3497
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 616287
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3498
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1541928
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3499
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 616292
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3500
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1357547
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0