CMS Formulary

Displaying 3951-3960 of 1611142 results.
ID: 3951
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593833
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 3952
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593835
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3953
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593775
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 3954
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861045
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 28
ID: 3955
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861043
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 28
ID: 3956
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 206347
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3957
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 801357
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3958
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 801112
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3959
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 801136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 3960
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799706
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0