CMS Formulary

Displaying 39301-39310 of 1611142 results.
ID: 39301
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747567
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 39302
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747580
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39303
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921017
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39304
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921010
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39305
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39306
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 152971
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39307
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2166143
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39308
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2196900
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39309
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1873087
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39310
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940709
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28