CMS Formulary

Displaying 3681-3690 of 1611142 results.
ID: 3681
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 309958
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3682
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 309960
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3683
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 3684
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3685
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3686
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1314763
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3687
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 312594
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3688
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198141
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3689
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 834046
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3690
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 834040
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0