CMS Formulary

Displaying 3891-3900 of 1611142 results.
ID: 3891
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 3892
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3893
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197444
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3894
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197445
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3895
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197816
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3896
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197815
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3897
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1001004
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3898
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 351264
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 3899
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 904605
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3900
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 904571
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0