CMS Formulary

Displaying 3921-3930 of 1611142 results.
ID: 3921
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 351174
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3922
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3923
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 794639
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3924
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 616578
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3925
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 801417
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3926
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3927
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3928
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 800928
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3929
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 800812
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3930
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1189640
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0