CMS Formulary

Displaying 39411-39420 of 1611142 results.
ID: 39411
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 198047
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39412
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 312059
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39413
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 866018
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39414
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 603103
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39415
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 106346
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 220
Qty Limit Days: 30
ID: 39416
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098649
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39417
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098670
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39418
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098674
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39419
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923422
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39420
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923426
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0