CMS Formulary

Displaying 39651-39660 of 1611142 results.
ID: 39651
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 197979
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39652
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 197978
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39653
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1246306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 39654
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1246290
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 39655
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39656
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39657
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1872261
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39658
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055008
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39659
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 991233
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39660
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 308047
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30