CMS Formulary

Displaying 3741-3750 of 1611142 results.
ID: 3741
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 310534
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3742
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1362706
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3743
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1362712
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3744
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1362720
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3745
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 308865
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3746
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860154
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3747
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860151
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3748
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860127
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3749
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 856448
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3750
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 856457
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0