CMS Formulary

Displaying 3931-3940 of 1611142 results.
ID: 3931
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 800933
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3932
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001321
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 3933
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091843
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3934
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 402091
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3935
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986819
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3936
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2289424
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 3937
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2289428
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3938
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1942485
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3939
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1942489
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 3940
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2047639
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30