CMS Formulary

Displaying 351-360 of 1611142 results.
ID: 351
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923056
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 70
Qty Limit Days: 28
ID: 352
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923058
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 353
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 354
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 355
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123314
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 356
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121096
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 357
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121100
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 358
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2390954
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 359
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 360
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0