CMS Formulary

Displaying 3841-3850 of 1611142 results.
ID: 3841
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 866049
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3842
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896019
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3843
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896027
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3844
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896023
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3845
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 213484
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3846
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 759473
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 180
ID: 3847
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896185
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3848
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896212
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3849
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896229
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3850
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 896237
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30