CMS Formulary

Displaying 3551-3560 of 1611142 results.
ID: 3551
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 825170
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3552
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801278
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3553
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 847741
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3554
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 835892
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3555
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2056897
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3556
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 746609
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 3557
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 845518
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 3558
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 845512
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 3559
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 847734
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3560
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 860244
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30