CMS Formulary

Displaying 3801-3810 of 1611142 results.
ID: 3801
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197405
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3802
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 103401
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3803
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 242736
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3804
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 706546
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3805
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 311033
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 3806
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 311027
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 3807
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 213442
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 3808
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860172
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 28
ID: 3809
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2206092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 3810
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2206099
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28