CMS Formulary

Displaying 3771-3780 of 1611142 results.
ID: 3771
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3772
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3773
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3774
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3775
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 3776
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 308963
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3777
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 317173
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3778
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 308964
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3779
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197604
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3780
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197606
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0