CMS Formulary

Displaying 3861-3870 of 1611142 results.
ID: 3861
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648789
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3862
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1945048
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3863
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2045382
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3864
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2109239
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3865
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2170993
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 3866
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173822
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 3867
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2395775
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3868
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 249066
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3869
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 207840
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3870
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178081
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0