CMS Formulary

Displaying 3581-3590 of 1611142 results.
ID: 3581
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425228
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3582
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245003
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 3583
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3584
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 825429
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3585
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 884619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3586
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 3587
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1656356
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3588
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859501
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 3589
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1919094
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 3590
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2169314
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28