CMS Formulary

Displaying 3821-3830 of 1611142 results.
ID: 3821
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991317
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 3822
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200654
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3823
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200658
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3824
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200650
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3825
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653204
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 3826
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 351926
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 3827
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 849851
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3828
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 847247
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3829
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 847348
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3830
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 847245
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0